Healthcare Provider Details

I. General information

NPI: 1962874479
Provider Name (Legal Business Name): BRENDA VAZQUEZ LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2015
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 GLEBE AVE
BRONX NY
10461-3109
US

IV. Provider business mailing address

2527 GLEBE AVE
BRONX NY
10461-3109
US

V. Phone/Fax

Practice location:
  • Phone: 718-904-4400
  • Fax: 718-904-7054
Mailing address:
  • Phone: 718-904-4400
  • Fax: 718-904-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071619-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: