Provider Demographics
NPI:1912528951
Name:WARGO, JANINE (PSY D)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:
Last Name:WARGO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8555
Mailing Address - Country:US
Mailing Address - Phone:610-554-6353
Mailing Address - Fax:484-298-3376
Practice Address - Street 1:4647 WILLOW LN
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8555
Practice Address - Country:US
Practice Address - Phone:610-554-6353
Practice Address - Fax:484-298-3376
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02008664103TS0200X
PAPS017115103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool