MEDICARE: VERONICA VAGANOV LMSW

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	122386	NY

General Provider Information

NPI Number	:	1629848452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA VAGANOV LMSW

Provider Business Mailing Address
First Line	:	404 ZENA RD STE 2
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-2627
Country	:	US
Telephone Number	:	845-679-8650
Fax Number	:	845-679-5485

Provider Business Practice Location Address
First Line	:	404 ZENA RD STE 2
Second Line	:
City	:	WOODSTOCK
State	:	NY
Zip	:	12498-2627
Country	:	US
Telephone Number	:	845-679-8650
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	10/09/2025

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