| Doctor Name: | JOSE VARGAS |
| NPI Number: | 1174727440 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, CASAC |
| License Number: | 16811 |
| Business Practice Address: | 14 Mill Dr Mastic Beach, NY - 119511803 |
| Business Phone Number: | 6317458205 |
| Business Fax Number: | |
| Mailing Address: | 14 Mill Dr, MASTIC BEACH |
| State: | NY |
| Postal Code: | 119511803 |
| Phone Number: | 6317458205 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2007 |
| NPI Last Update Date: | 10/23/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 16811 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |