Provider Demographics
NPI:1396944138
Name:VAZQUEZ, DENNISSE (MSW, LADC)
Entity type:Individual
Prefix:
First Name:DENNISSE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FARMINGTON AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2977
Mailing Address - Country:US
Mailing Address - Phone:860-902-7050
Mailing Address - Fax:860-902-7050
Practice Address - Street 1:106 FARMINGTON AVE STE 2B
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2977
Practice Address - Country:US
Practice Address - Phone:860-902-7050
Practice Address - Fax:860-902-7050
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CT883101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical