Provider Demographics
NPI:1659112365
Name:VARGAS, CARMEN TAMARA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:TAMARA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CAMPBELL TER
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4812
Mailing Address - Country:US
Mailing Address - Phone:347-904-4468
Mailing Address - Fax:
Practice Address - Street 1:58 CAMPBELL TER
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4812
Practice Address - Country:US
Practice Address - Phone:347-904-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician