Provider Demographics
NPI:1710614730
Name:VASQUEZ, KAREN A (CASAC)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:POLLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATLEY HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11798-2333
Mailing Address - Country:US
Mailing Address - Phone:516-229-1706
Mailing Address - Fax:
Practice Address - Street 1:45 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:WHEATLEY HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11798-2333
Practice Address - Country:US
Practice Address - Phone:516-229-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12575101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)