Provider Demographics
NPI:1356482814
Name:VAZQUEZ, NILDA R (BS)
Entity Type:Individual
Prefix:MRS
First Name:NILDA
Middle Name:R
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2103
Mailing Address - Country:US
Mailing Address - Phone:203-755-1192
Mailing Address - Fax:203-575-9675
Practice Address - Street 1:56 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2103
Practice Address - Country:US
Practice Address - Phone:203-755-1192
Practice Address - Fax:203-575-9675
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health