Provider Demographics
NPI:1194313932
Name:VASQUEZ, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:VASQUEZ
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 1:17 ARCADIAN WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1245
Mailing Address - Country:US
Mailing Address - Phone:201-655-3342
Mailing Address - Fax:
Practice Address - Street 1:17 ARCADIAN WAY STE 108
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1245
Practice Address - Country:US
Practice Address - Phone:201-655-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker