Basic Information
| Provider Information | |||||||||
| NPI: | 1114077195 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | ELIEZER | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 POPLARWOOD CT | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276041084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198727373 | ||||||||
| FaxNumber: | 9198723713 | ||||||||
| Practice Location | |||||||||
| Address1: | 2809 HIGHWOODS BLVD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276041000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198727373 | ||||||||
| FaxNumber: | 9198723713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C005393 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.