MEDICARE: MARIA DE LOS ANGELES VARGAS - CANCEL LCSW

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	1041C0700X	Clinical Social Worker	127218	MA
2	1041C0700X	Clinical Social Worker	65814	TX
3	1041C0700X	Clinical Social Worker	ISW04639	RI

General Provider Information

NPI Number	:	1295320513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA DE LOS ANGELES VARGAS - CANCEL LCSW

Provider Business Mailing Address
First Line	:	16903 RED OAK DR STE 130F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3965
Country	:	US
Telephone Number	:	346-221-4649
Fax Number	:

Provider Business Practice Location Address
First Line	:	16903 RED OAK DR STE 130F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77090-3965
Country	:	US
Telephone Number	:	346-221-4649
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	12/11/2025

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