Healthcare Provider Details

I. General information

NPI: 1659014074
Provider Name (Legal Business Name): ABIGAIL CARABALLO VARGAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA ROSA 43-16 AVE. PRINCIPAL OFICINA #3
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 775
BAYAMON PR
00960-0775
US

V. Phone/Fax

Practice location:
  • Phone: 939-247-3364
  • Fax:
Mailing address:
  • Phone: 939-247-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15953
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: