Provider Demographics
NPI:1629387444
Name:VAZQUEZ, RENE GILBERTO (DSW)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:GILBERTO
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 81ST ST
Mailing Address - Street 2:APT 4I
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6970
Mailing Address - Country:US
Mailing Address - Phone:917-922-5684
Mailing Address - Fax:
Practice Address - Street 1:3725 81ST ST
Practice Address - Street 2:APT 4I
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6970
Practice Address - Country:US
Practice Address - Phone:917-922-5684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR025542-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical