Provider Demographics
NPI:1275958753
Name:VAZQUEZ, FREDDIE (CASAC)
Entity Type:Individual
Prefix:
First Name:FREDDIE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 UNION SQ W
Mailing Address - Street 2:FLOOR 7
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3304
Mailing Address - Country:US
Mailing Address - Phone:212-627-9600
Mailing Address - Fax:212-627-4040
Practice Address - Street 1:19 UNION SQ W
Practice Address - Street 2:FLOOR 7
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3304
Practice Address - Country:US
Practice Address - Phone:212-627-9600
Practice Address - Fax:212-627-4040
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19114101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)