Provider Demographics
NPI:1467655266
Name:VAZQUEZ, JENNIFER MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1546
Mailing Address - Country:US
Mailing Address - Phone:510-300-3500
Mailing Address - Fax:
Practice Address - Street 1:100 BLANKEN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134
Practice Address - Country:US
Practice Address - Phone:415-330-5740
Practice Address - Fax:415-330-9120
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW226491041C0700X
LCSW709241041C0700X
CALCSW709241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
8905OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
8905OtherSFGH INTERNAL USE ONLY