Provider Demographics
NPI:1750468104
Name:VARGAS-BOGARDUS, LOURDES AMALIA (LMFT)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:AMALIA
Last Name:VARGAS-BOGARDUS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:AMALIA
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:NAVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948
Mailing Address - Country:US
Mailing Address - Phone:415-505-5523
Mailing Address - Fax:
Practice Address - Street 1:1368 LINCOLN AVE SUITE 212
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-505-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT36776101YM0800X
CAMFC36776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health