Provider Demographics
NPI:1649018995
Name:VASQUEZ, CHENYL
Entity type:Individual
Prefix:MRS
First Name:CHENYL
Middle Name:
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 1:1178 BROADWAY FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5666
Mailing Address - Country:US
Mailing Address - Phone:917-284-9393
Mailing Address - Fax:917-284-9393
Practice Address - Street 1:20 WOODSEDGE DR
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4254
Practice Address - Country:US
Practice Address - Phone:917-284-9393
Practice Address - Fax:917-284-9393
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician