Provider Demographics
NPI:1861748311
Name:VARGHESE, MARY E (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOLLY HILL LN
Mailing Address - Street 2:SUITE 240
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6074
Mailing Address - Country:US
Mailing Address - Phone:203-863-2926
Mailing Address - Fax:203-863-3744
Practice Address - Street 1:55 HOLLY HILL LN
Practice Address - Street 2:SUITE 240
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6074
Practice Address - Country:US
Practice Address - Phone:203-863-2926
Practice Address - Fax:203-863-3744
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
CT003596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator