Provider Demographics
NPI:1649991597
Name:VASILE, GEOFFREY AZAD (LMSW)
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:AZAD
Last Name:VASILE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 TRINITY ST STOP A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78712-1766
Mailing Address - Country:US
Mailing Address - Phone:512-953-3730
Mailing Address - Fax:
Practice Address - Street 1:1601 TRINITY ST STOP A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1766
Practice Address - Country:US
Practice Address - Phone:737-231-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty