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General NPI Number Information
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NPI Number | 1134509979
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Entity Type | Individual
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Provider Name | ROSHNEE VAZQUEZ PHD
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Gender | Female
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Dates
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Enumeration Date | 06/07/2015
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 205 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10016-6022
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Country | US
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Telephone | 551-482-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 648 BOULEVARD E 2ND FLOOR
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City | WEEHAWKEN
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State | NJ
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Zip | 07086-6811
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Country | US
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Telephone | 551-482-0155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35SI00534200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 020515
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License Number State | NY
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