Provider Demographics
NPI:1790290203
Name:WASHINGTON, VANESSA J
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 VREELAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5813
Mailing Address - Country:US
Mailing Address - Phone:718-904-1434
Mailing Address - Fax:
Practice Address - Street 1:1326 VREELAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-5813
Practice Address - Country:US
Practice Address - Phone:718-904-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency