Provider Demographics
NPI:1215300959
Name:VARGAS, MABEL A (LAC)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:A
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 HARTMANN AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-2211
Mailing Address - Country:US
Mailing Address - Phone:201-424-1906
Mailing Address - Fax:
Practice Address - Street 1:94 HARTMANN AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2211
Practice Address - Country:US
Practice Address - Phone:201-424-1906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00272700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor