Provider Demographics
NPI:1912732264
Name:VAZQUEZ, JENNIFER (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 SAGE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3626
Mailing Address - Country:US
Mailing Address - Phone:773-255-3198
Mailing Address - Fax:
Practice Address - Street 1:5840 W INTERSTATE 20 STE 140
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-2809
Practice Address - Country:US
Practice Address - Phone:817-914-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114131104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker