Provider Demographics
NPI:1417190158
Name:VASQUEZ, JOSE A (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HUDSON STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-366-0066
Mailing Address - Fax:212-366-0050
Practice Address - Street 1:315 HUDSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1009
Practice Address - Country:US
Practice Address - Phone:212-366-0066
Practice Address - Fax:212-366-0050
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker