Healthcare Provider Details

I. General information

NPI: 1720902869
Provider Name (Legal Business Name): MINDY VARGAS, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 COLORADO BLVD
SANTA ROSA CA
95405-7114
US

IV. Provider business mailing address

1275 4TH ST # 5021
SANTA ROSA CA
95404-4057
US

V. Phone/Fax

Practice location:
  • Phone: 369-210-7070
  • Fax:
Mailing address:
  • Phone: 369-210-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. MINDY VARGAS
Title or Position: PRESIDENT
Credential: LCSW
Phone: 369-210-7070