Provider Demographics
NPI:1801492087
Name:VERGARA ANDUEZA, MARIA ROSARIO (MA)
Entity type:Individual
Prefix:
First Name:MARIA ROSARIO
Middle Name:
Last Name:VERGARA ANDUEZA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3014
Mailing Address - Country:US
Mailing Address - Phone:720-377-8202
Mailing Address - Fax:
Practice Address - Street 1:2850 7TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3014
Practice Address - Country:US
Practice Address - Phone:720-377-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty