Provider Demographics
NPI:1285091371
Name:VASQUEZ-RESTITUYO, LISSETTE
Entity type:Individual
Prefix:MRS
First Name:LISSETTE
Middle Name:
Last Name:VASQUEZ-RESTITUYO
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 1:4419 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2562
Mailing Address - Country:US
Mailing Address - Phone:347-515-4799
Mailing Address - Fax:
Practice Address - Street 1:234 EUGENIO MARIA DE HOSTOS BLVD (E 149TH ST)
Practice Address - Street 2:1C2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451
Practice Address - Country:US
Practice Address - Phone:718-579-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0887531041C0700X
NY0942231104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker