Provider Demographics
NPI:1114170842
Name:VASQUEZ-RODRIGUEZ, CARMEN LUZ
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LUZ
Last Name:VASQUEZ-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CARMEN
Other - Middle Name:LUZ
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1662 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4905
Mailing Address - Country:US
Mailing Address - Phone:917-626-3169
Mailing Address - Fax:718-677-4140
Practice Address - Street 1:1662 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4905
Practice Address - Country:US
Practice Address - Phone:917-626-3169
Practice Address - Fax:718-677-4140
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-26
Last Update Date:2008-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0750821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical