MEDICARE: SUZANNE VARGAS LICENSED CLINICAL SOCIAL WORKER INC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1508431628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE VARGAS LICENSED CLINICAL SOCIAL WORKER INC

Provider Business Mailing Address
First Line	:	38970 BLACOW RD STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-7380
Country	:	US
Telephone Number	:	510-408-7213
Fax Number	:	510-745-9031

Provider Business Practice Location Address
First Line	:	38970 BLACOW RD STE C
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94536-7380
Country	:	US
Telephone Number	:	510-408-7213
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	SUZANNE VARGAS
Credential	:	LCSW
Telephone Number	:	510-408-7213

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	06/01/2026

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