| Doctor Name: | ELLISE VASQUEZ |
| NPI Number: | 1154737328 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS |
| License Number: | |
| Business Practice Address: | 141 E Main St 3rd Floor Home Based Services Waterbury, CT - 067022310 |
| Business Phone Number: | 2035750466 |
| Business Fax Number: | 2032067937 |
| Mailing Address: | 141 E Main St, 4th Floor Administration WATERBURY |
| State: | CT |
| Postal Code: | 067022310 |
| Phone Number: | 2035749000 |
| Fax Number: | 2035749006 |
| NPI Enumeration Date: | 07/08/2014 |
| NPI Last Update Date: | 07/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |