MEDICARE: MRS. JENNY VASQUEZ-SHUBITZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	062869	NY

General Provider Information

NPI Number	:	1447335799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY VASQUEZ-SHUBITZ LCSW

Provider Business Mailing Address
First Line	:	3722 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7032
Country	:	US
Telephone Number	:	718-779-1600
Fax Number	:	718-803-0895

Provider Business Practice Location Address
First Line	:	3722 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7032
Country	:	US
Telephone Number	:	718-779-1600
Fax Number	:	718-803-0895

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	08/04/2010

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