Healthcare Provider Details

I. General information

NPI: 1174431324
Provider Name (Legal Business Name): ROSA IRIS VARGAS THOMAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 UNION SQ UNIT 1214
SOUTHBURY CT
06488-2204
US

IV. Provider business mailing address

30 ROLLING HILLS DR
OXFORD CT
06478-6140
US

V. Phone/Fax

Practice location:
  • Phone: 203-218-0043
  • Fax:
Mailing address:
  • Phone: 203-218-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17238
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: