MEDICARE: MS. MADELINE VARGAS

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1356619571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADELINE VARGAS

Provider Business Mailing Address
First Line	:	535 FLUSHING AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1610
Country	:	US
Telephone Number	:	929-800-2340
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 FLUSHING AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-1610
Country	:	US
Telephone Number	:	929-800-2340
Fax Number	:

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

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	01/19/2021

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