Provider Demographics
NPI:1669941886
Name:VAZQUEZ, DEBORA
Entity type:Individual
Prefix:MISS
First Name:DEBORA
Middle Name:
Last Name:VAZQUEZ
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 1:735 LINCOLN AVE APT 4R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4131
Mailing Address - Country:US
Mailing Address - Phone:352-653-7537
Mailing Address - Fax:
Practice Address - Street 1:6800 JERICHO TPKE STE 120W
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4445
Practice Address - Country:US
Practice Address - Phone:516-393-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker