Provider Demographics
NPI:1427840776
Name:VASQUEZ, LUIS ANDRES
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANDRES
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 WINTERS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18202-3728
Mailing Address - Country:US
Mailing Address - Phone:570-453-7879
Mailing Address - Fax:
Practice Address - Street 1:790 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-8799
Practice Address - Country:US
Practice Address - Phone:570-351-4630
Practice Address - Fax:272-207-2506
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional