Provider Demographics
NPI:1811105802
Name:VAZQUEZ, CARMEN INOA
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:INOA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:I
Other - Last Name:VAZQUEZ,PSYCHOLOGIST, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:104 E 40TH ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1801
Mailing Address - Country:US
Mailing Address - Phone:212-972-1777
Mailing Address - Fax:212-689-5018
Practice Address - Street 1:104 E 40TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1801
Practice Address - Country:US
Practice Address - Phone:212-972-1777
Practice Address - Fax:212-689-5018
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007873-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist