Provider Demographics
NPI:1447817945
Name:VARGAS, ANA EUGENIA (LCSW)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:EUGENIA
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 1:13546 GYPSUM DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9165
Mailing Address - Country:US
Mailing Address - Phone:909-559-2270
Mailing Address - Fax:
Practice Address - Street 1:2585 S ARCHIBALD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-6510
Practice Address - Country:US
Practice Address - Phone:909-947-2205
Practice Address - Fax:909-947-1605
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS181451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical