Provider Demographics
NPI:1609109248
Name:VAZQUEZ, LIDUVINA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:LIDUVINA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3873
Mailing Address - Country:US
Mailing Address - Phone:516-868-3030
Mailing Address - Fax:516-868-3374
Practice Address - Street 1:17 W MERRICK RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3873
Practice Address - Country:US
Practice Address - Phone:516-868-3030
Practice Address - Fax:516-868-3374
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst