MEDICARE: MRS. CYNTHIA DEANN VASQUEZ 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	0904014459	VA
2	1041C0700X	Clinical Social Worker	31607	TX

General Provider Information

NPI Number	:	1902039191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA DEANN VASQUEZ LCSW

Provider Business Mailing Address
First Line	:	3073 S BUCHANAN ST APT A1
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-1518
Country	:	US
Telephone Number	:	817-629-6759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 EYE STREET NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20420-1524
Country	:	US
Telephone Number	:	202-894-0931
Fax Number	:

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

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	01/03/2023

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