Provider Demographics
NPI:1780336156
Name:VASQUEZ, ISABELLA (MA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 NEW BERN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-1846
Mailing Address - Country:US
Mailing Address - Phone:817-627-7929
Mailing Address - Fax:
Practice Address - Street 1:9620 NEW BERN DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-1846
Practice Address - Country:US
Practice Address - Phone:817-627-7929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical