Provider Demographics
NPI:1114077195
Name:VAZQUEZ, ELIEZER (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIEZER
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 POPLARWOOD CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1084
Mailing Address - Country:US
Mailing Address - Phone:919-872-7373
Mailing Address - Fax:919-872-3713
Practice Address - Street 1:2809 HIGHWOODS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1000
Practice Address - Country:US
Practice Address - Phone:919-872-7373
Practice Address - Fax:919-872-3713
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical