Provider Demographics
NPI:1508945536
Name:VAZQUEZ, ROSA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 BROADWAY STE 643
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6818
Mailing Address - Country:US
Mailing Address - Phone:212-529-8545
Mailing Address - Fax:212-529-8747
Practice Address - Street 1:799 BROADWAY STE 643
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6818
Practice Address - Country:US
Practice Address - Phone:212-529-8545
Practice Address - Fax:212-529-8737
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010895103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical