Provider Demographics
NPI:1023753092
Name:VASQUEZ, ALICIA SABINA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:SABINA
Last Name:VASQUEZ
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 1:15414 CALSHOT CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-2967
Mailing Address - Country:US
Mailing Address - Phone:301-377-9172
Mailing Address - Fax:
Practice Address - Street 1:10015 OLD COLUMBIA RD STE F100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1755
Practice Address - Country:US
Practice Address - Phone:443-741-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician