Healthcare Provider Details

I. General information

NPI: 1922719947
Provider Name (Legal Business Name): REBECCA LEWIS VARGHESE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79780 MIRA FLORES BLVD
LA QUINTA CA
92253-8204
US

IV. Provider business mailing address

79780 MIRA FLORES BLVD
LA QUINTA CA
92253-8204
US

V. Phone/Fax

Practice location:
  • Phone: 843-422-1383
  • Fax:
Mailing address:
  • Phone: 843-422-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW112248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: