Provider Demographics
NPI:1265832943
Name:VAZQUEZ, MILTON (MSW)
Entity Type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-5036
Mailing Address - Country:US
Mailing Address - Phone:413-737-5167
Mailing Address - Fax:413-733-0537
Practice Address - Street 1:95 ASHLEY AVE STE A
Practice Address - Street 2:SPRINGFIELD VET CENTER
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1352
Practice Address - Country:US
Practice Address - Phone:413-737-5167
Practice Address - Fax:413-733-0537
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA