Provider Demographics
NPI:1770724890
Name:VARGAS, MYRNA IVETTE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MYRNA
Middle Name:IVETTE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SILAS DEANE HWY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2124
Mailing Address - Country:US
Mailing Address - Phone:860-721-0606
Mailing Address - Fax:860-721-0202
Practice Address - Street 1:415 SILAS DEANE HWY
Practice Address - Street 2:SUITE 402
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2124
Practice Address - Country:US
Practice Address - Phone:860-721-0606
Practice Address - Fax:860-721-0202
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0037981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical