Healthcare Provider Details

I. General information

NPI: 1700797735
Provider Name (Legal Business Name): HEIDI ROSSMERY VARGAS SOCIAL WORK STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 ROUTE 17K STE 220
NEWBURGH NY
12550-8345
US

IV. Provider business mailing address

2255 STATE ROUTE 32 UNIT 619
MODENA NY
12548-7027
US

V. Phone/Fax

Practice location:
  • Phone: 845-200-9230
  • Fax: 949-561-5645
Mailing address:
  • Phone: 845-200-9230
  • Fax: 949-561-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: