Provider Demographics
NPI:1962986059
Name:PORTALATIN DE VARGAS, HELEN
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:PORTALATIN DE VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:PORTALATIN DE VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY
Mailing Address - Street 1:125 GUADALAJARA DR STE 3
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-6607
Mailing Address - Country:US
Mailing Address - Phone:689-296-4154
Mailing Address - Fax:
Practice Address - Street 1:2900 17TH ST STE 3
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6098
Practice Address - Country:US
Practice Address - Phone:800-614-4124
Practice Address - Fax:888-217-4124
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
FLIMH20558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty