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General NPI Number Information
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NPI Number | 1255224507
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Entity Type | Individual
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Provider Name | MARYSSA VASQUEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 855 MONTGOMERY ST
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City | FORT WORTH
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State | TX
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Zip | 76107-2553
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Country | US
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Telephone | 817-735-2228
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Fax | 817-735-2099
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Provider Business Mailing Address
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Address Line | PO BOX 99335
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City | FORT WORTH
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State | TX
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Zip | 76199-0335
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Country | US
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Telephone | 817-735-2228
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Fax | 817-735-2099
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 106451
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License Number State | TX
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