Basic Information
| Provider Information | |||||||||
| NPI: | 1336623552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VASQUEZ-VALDEZ | ||||||||
| FirstName: | BRADLEE | ||||||||
| MiddleName: | RAPHIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3164 MEADOWBROOK BLVD FL 2 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441182802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142674594 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3518 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441091951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167412241 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2018 | ||||||||
| LastUpdateDate: | 09/24/2018 | ||||||||
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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 | 104100000X | 1800471 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.