Provider Demographics
NPI:1346394608
Name:VAZQUEZ, PEDRO (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 A MAGNOLIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306
Mailing Address - Country:US
Mailing Address - Phone:201-653-8027
Mailing Address - Fax:
Practice Address - Street 1:401 E 147TH STREET
Practice Address - Street 2:NEW BEGINNINGS COMMUNITY COUNSELING CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-402-5244
Practice Address - Fax:718-665-2456
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05013111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical