Provider Demographics
NPI:1588938435
Name:AMADOR, VENNESSA VASQUEZ
Entity type:Individual
Prefix:MRS
First Name:VENNESSA
Middle Name:VASQUEZ
Last Name:AMADOR
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 1:4230 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1012
Mailing Address - Country:US
Mailing Address - Phone:575-640-8902
Mailing Address - Fax:
Practice Address - Street 1:4230 HARRISON ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1012
Practice Address - Country:US
Practice Address - Phone:575-640-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst