Provider Demographics
NPI:1174796676
Name:VARGAS, VICTORIA A (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:A
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:505 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-5020
Mailing Address - Country:US
Mailing Address - Phone:410-341-3420
Mailing Address - Fax:410-341-3397
Practice Address - Street 1:505 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5020
Practice Address - Country:US
Practice Address - Phone:410-341-3420
Practice Address - Fax:410-341-3397
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706231041C0700X
MD187271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070623Medicaid