Provider Demographics
NPI:1063212496
Name:VAZQUEZ QUIROZ, JESUS ROGELIO (MA)
Entity type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ROGELIO
Last Name:VAZQUEZ QUIROZ
Suffix:
Gender:
Credentials:MA
Other - Prefix:MR
Other - First Name:JESUS
Other - Middle Name:ROGELIO
Other - Last Name:VAZQUEZ QUIROZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:80 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-4704
Mailing Address - Country:US
Mailing Address - Phone:413-540-6332
Mailing Address - Fax:
Practice Address - Street 1:80 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-4704
Practice Address - Country:US
Practice Address - Phone:413-540-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health