Provider Demographics
NPI:1396556098
Name:VARGAS, PAOLA FERNANDA (LMSW)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:FERNANDA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FULKERSON DR APT 3A
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1423
Mailing Address - Country:US
Mailing Address - Phone:203-560-7039
Mailing Address - Fax:
Practice Address - Street 1:106 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2949
Practice Address - Country:US
Practice Address - Phone:860-901-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT21640081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker