Provider Demographics
NPI:1497902464
Name:VASQUEZ, MIGUEL (LMSW)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3803
Mailing Address - Country:US
Mailing Address - Phone:575-445-7090
Mailing Address - Fax:575-445-7663
Practice Address - Street 1:101 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3803
Practice Address - Country:US
Practice Address - Phone:575-445-7090
Practice Address - Fax:575-445-7663
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool