Provider Demographics
NPI:1194088609
Name:VASQUEZ-LEIVA, CHRISTINA ROSA (LCSW82547)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ROSA
Last Name:VASQUEZ-LEIVA
Suffix:
Gender:F
Credentials:LCSW82547
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ROSA
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW82547
Mailing Address - Street 1:30030 MISSION BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7252
Mailing Address - Country:US
Mailing Address - Phone:510-207-7644
Mailing Address - Fax:
Practice Address - Street 1:802 BREWSTER AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1510
Practice Address - Country:US
Practice Address - Phone:650-241-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW82547261QM0801X
CA825471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)