MEDICARE: JACQUELINE MARIA VARGAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	18597	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124756101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MARIA VARGAS LCSW

Provider Business Mailing Address
First Line	:	3564 AVALON PARK EAST BLVD STE 1
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7365
Country	:	US
Telephone Number	:	863-256-9604
Fax Number	:

Provider Business Practice Location Address
First Line	:	3564 AVALON PARK EAST BLVD STE 1
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7365
Country	:	US
Telephone Number	:	863-256-9604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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