Provider Demographics
NPI:1073379236
Name:VASQUEZ, KATHERINE VASQUEZ N/A (CASAC-T)
Entity type:Individual
Prefix:MS
First Name:KATHERINE VASQUEZ
Middle Name:N/A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC-T
Mailing Address - Street 1:770 E 176TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4617
Mailing Address - Country:US
Mailing Address - Phone:718-583-5150
Mailing Address - Fax:
Practice Address - Street 1:770 E 176TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4617
Practice Address - Country:US
Practice Address - Phone:718-583-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)