Provider Demographics
NPI:1871507475
Name:VASQUEZ, STACY M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:M
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 RAMROD AVE
Mailing Address - Street 2:1212
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2008
Mailing Address - Country:US
Mailing Address - Phone:702-860-4549
Mailing Address - Fax:
Practice Address - Street 1:2120 RAMROD AVE
Practice Address - Street 2:1212
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2008
Practice Address - Country:US
Practice Address - Phone:702-860-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-5201041C0700X
NV2789-S104100000X
NV5763-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker