Provider Demographics
NPI:1881605004
Name:VON VARGA, SASHA P (LCSW)
Entity type:Individual
Prefix:MR
First Name:SASHA
Middle Name:P
Last Name:VON VARGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:SASHA
Other - Middle Name:P
Other - Last Name:VON KIBEDI VARGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:466 CENTRAL AVE
Mailing Address - Street 2:SUITE #27
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3041
Mailing Address - Country:US
Mailing Address - Phone:847-446-7924
Mailing Address - Fax:847-446-7924
Practice Address - Street 1:466 CENTRAL AVE
Practice Address - Street 2:SUITE #27
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3041
Practice Address - Country:US
Practice Address - Phone:847-446-7924
Practice Address - Fax:847-446-7924
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0085051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149-008505OtherSTATE LICENSE