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General NPI Number Information
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NPI Number | 1770724890
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Entity Type | Individual
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Provider Name | MYRNA IVETTE VARGAS L.C.S.W
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Gender | Female
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 415 SILAS DEANE HWY SUITE 402
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City | WETHERSFIELD
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State | CT
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Zip | 06109-2124
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Country | US
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Telephone | 860-721-0606
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Fax | 860-721-0202
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Provider Business Mailing Address
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Address Line | 415 SILAS DEANE HWY SUITE 402
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City | WETHERSFIELD
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State | CT
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Zip | 06109-2124
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Country | US
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Telephone | 860-721-0606
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Fax | 860-721-0202
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003798
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License Number State | CT
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