Provider Demographics
NPI:1154481893
Name:MARQUEZ-BANTZ, VILMA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VILMA
Middle Name:
Last Name:MARQUEZ-BANTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2400
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:94-98 MANHATTAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:10010-1600
Practice Address - Country:US
Practice Address - Phone:718-388-0390
Practice Address - Fax:718-486-5741
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083355-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NYW6L111Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331946Medicare Oscar/Certification