Provider Demographics
NPI:1558069328
Name:VAZQUEZ, MELINDA (LMSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 MILL ST
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1427
Mailing Address - Country:US
Mailing Address - Phone:845-871-1000
Mailing Address - Fax:
Practice Address - Street 1:43 ALDEN PL
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5881
Practice Address - Country:US
Practice Address - Phone:845-677-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107707101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool