Provider Demographics
NPI:1447482393
Name:VARGO, LORI RENEE (CSW)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RENEE
Last Name:VARGO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E FRONT ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2477
Mailing Address - Country:US
Mailing Address - Phone:734-240-0372
Mailing Address - Fax:734-481-0090
Practice Address - Street 1:105 E FRONT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2477
Practice Address - Country:US
Practice Address - Phone:734-240-0372
Practice Address - Fax:734-481-0090
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1532194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional