Provider Demographics
NPI:1184796757
Name:VASQUEZ, JOSE J (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:J
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 ROUTE 9
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-632-2939
Mailing Address - Fax:845-632-2940
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:SUITE 7B
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037723-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1184796757Medicaid