Provider Demographics
NPI:1649499641
Name:VARGHESE, SHABU ABRAHAM (LCSW)
Entity type:Individual
Prefix:
First Name:SHABU
Middle Name:ABRAHAM
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13902 N DALE MABRY HWY STE 118
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2424
Mailing Address - Country:US
Mailing Address - Phone:813-892-1252
Mailing Address - Fax:
Practice Address - Street 1:13902 N DALE MABRY HWY STE 118
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2424
Practice Address - Country:US
Practice Address - Phone:813-892-1252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW80951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical