Provider Demographics
NPI:1235107756
Name:QUEZADA, SYLVIA TRISTAN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:TRISTAN
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:SYLVIA
Other - Middle Name:T
Other - Last Name:WIRTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:USAHCH
Mailing Address - Street 2:CMR 470, BOX 4867
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09165
Mailing Address - Country:DE
Mailing Address - Phone:0114-961-8188
Mailing Address - Fax:8874
Practice Address - Street 1:USAHCH
Practice Address - Street 2:CMR 470, BOX 4867
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09165
Practice Address - Country:DE
Practice Address - Phone:0114-961-8188
Practice Address - Fax:8874
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS 058181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical