Provider Demographics
NPI:1922302470
Name:VAZQUEZ, MARLYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARLYN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARLYN
Other - Middle Name:
Other - Last Name:MONTALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:64 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2613
Mailing Address - Country:US
Mailing Address - Phone:203-573-7210
Mailing Address - Fax:203-573-7362
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:POMEROY 8
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-7210
Practice Address - Fax:203-573-7362
Is Sole Proprietor?:No
Enumeration Date:2010-12-26
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0060141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical