MEDICARE: MS. CASSANDRA LEE VARGAS M.A., L.P.C., N.C.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1114279247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRA LEE VARGAS M.A., L.P.C., N.C.C.

Provider Business Mailing Address
First Line	:	744 N CLARK ST APT 402
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-2582
Country	:	US
Telephone Number	:	949-981-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	744 N CLARK ST APT 402
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-2582
Country	:	US
Telephone Number	:	949-981-2975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2012
Last Update Date	:	10/13/2012

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