Provider Demographics
NPI:1841497914
Name:VASQUEZ, ANISA LONGORIA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ANISA
Middle Name:LONGORIA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 LUNDY ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-3518
Mailing Address - Country:US
Mailing Address - Phone:979-578-9667
Mailing Address - Fax:979-578-9667
Practice Address - Street 1:608 LUNDY ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-3518
Practice Address - Country:US
Practice Address - Phone:979-578-9667
Practice Address - Fax:979-578-9667
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker