Provider Demographics
NPI:1528374758
Name:VASQUEZ, MATTHEW LORENZO (LMSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LORENZO
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 1:269 HAWKEYE CT
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3113 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPID
Practice Address - State:IA
Practice Address - Zip Code:52405
Practice Address - Country:US
Practice Address - Phone:319-899-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007544104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker