Individual provider Active NPI

Rene Gilberto Vazquez, DSW

  • Clinical Social Worker
  • Jackson Heights, NY
National Provider Identifier
1629387444
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
PR025542-1 Issued in NY
Practice address
3725 81St St
Apt 4I
Jackson Heights, NY 11372-6970
Phone
(917) 922-5684
NPI assigned
Sep 28, 2010
Last updated
Oct 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X PR025542-1 NY Primary

Addresses

Primary practice location

3725 81St St
Apt 4I
Jackson Heights, NY 11372-6970

Mailing address

3725 81St St
Apt 4I
Jackson Heights, NY 11372-6970
Phone (917) 922-5684

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120926000180 NY Practitioner - Clinical Social Worker 3678722238 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PR025542-1NYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
George P Dempsey MD PC CurrentSince Sep 1, 2017 Accepting new patients
Bleuler Psychotherapy Center, Inc. CurrentSince Sep 23, 2023 Accepting new patients

Locations

200 Pantigo Pl
Ste I
East Hampton, NY 11937
Phone (631) 324-1953

10470 Queens Blvd
Ste 200
Forest Hills, NY 11375
Phone 7182756010 ext. 244

3764 72nd St
Jackson Hts, NY 11372
Phone (718) 335-3434

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/bleulerpc/r4/

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666310400000",
    "number": "1629387444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3725 81ST ST",
            "address_2": "APT 4I",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726970",
            "telephone_number": "917-922-5684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3725 81ST ST",
            "address_2": "APT 4I",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113726970",
            "telephone_number": "917-922-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZQUEZ",
        "first_name": "RENE",
        "middle_name": "GILBERTO",
        "name_prefix": "Dr.",
        "credential": "DSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-28",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "PR025542-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.