Basic Information
| Provider Information | |||||||||
| NPI: | 1669527867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARGO | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D., LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8019 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011028000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664314077 | ||||||||
| FaxNumber: | 4137747448 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 CONWAY ST | ||||||||
| Address2: | GREENFIELD HEALTH CENTER | ||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013011526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137746301 | ||||||||
| FaxNumber: | 4137746528 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 06/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 000332 | VT | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 5501 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 068-0000434 | VT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 92483 | 01 | MA | FALLON COMMUNITY HEALTH PLAN | OTHER | 33253 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 7804967 | 01 | MA | AETNA BH | OTHER | 2131434 | 01 | MA | CIGNA BH | OTHER | 815169000 | 01 | MA | MAGELLAN | OTHER | LM1372 | 01 | MA | BLUE CROSS BLUE SHIELD OF MA | OTHER |