Provider Demographics
NPI:1063684355
Name:VAZQUEZ, OLGA (LCSW CASAC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GREENWICH AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8384
Mailing Address - Country:US
Mailing Address - Phone:646-831-0727
Mailing Address - Fax:212-691-8661
Practice Address - Street 1:70 GREENWICH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8384
Practice Address - Country:US
Practice Address - Phone:646-831-0727
Practice Address - Fax:212-691-8661
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000843OtherMEDICARE