Provider Demographics
NPI:1154046159
Name:VARGAS, JOSHLYNN R (RBT)
Entity type:Individual
Prefix:
First Name:JOSHLYNN
Middle Name:R
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LEXINGTON PL NE APT 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1388
Mailing Address - Country:US
Mailing Address - Phone:505-315-6152
Mailing Address - Fax:
Practice Address - Street 1:2800 LEXINGTON PL NE APT 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1388
Practice Address - Country:US
Practice Address - Phone:505-315-6152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM505499661106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician