Provider Demographics
NPI:1184297145
Name:VAZQUEZ, YEIMI (MS)
Entity type:Individual
Prefix:
First Name:YEIMI
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KINGSLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1608
Mailing Address - Country:US
Mailing Address - Phone:120-128-3663
Mailing Address - Fax:
Practice Address - Street 1:440 EDGAR RD APT 202
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3485
Practice Address - Country:US
Practice Address - Phone:908-209-1406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty