Provider Demographics
NPI:1548421175
Name:MARQUEZ, VINCENT J (LCSW)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 SAN DIEGO AVE STE 136
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2943
Mailing Address - Country:US
Mailing Address - Phone:773-330-2144
Mailing Address - Fax:
Practice Address - Street 1:2247 SAN DIEGO AVE STE 136
Practice Address - Street 2:10650 SCRIPPS CANYON RD, STE 131, SAN DIEGO, CA 92131
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2943
Practice Address - Country:US
Practice Address - Phone:773-330-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health