Provider Demographics
NPI:1134509979
Name:VAZQUEZ, ROSHNEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSHNEE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 BOULEVARD E
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-6811
Mailing Address - Country:US
Mailing Address - Phone:551-482-0155
Mailing Address - Fax:
Practice Address - Street 1:205 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6022
Practice Address - Country:US
Practice Address - Phone:551-482-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-07
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00534200103T00000X
NY020515103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist