Active NPI
Rose I Vazquez-Santiago, LCSW,ACSW
- Clinical Social Worker
- Wallingford, CT
National Provider Identifier
1639102403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 00-388689
- Practice address
- 50 Gaylord Farm Rd
Wallingford, CT 06492-2899 - Phone
- (203) 284-2800
- Fax
- (203) 294-8734
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 00-388689 | CT | Primary |
Addresses
Primary practice location
50 Gaylord Farm Rd
Wallingford, CT 06492-2899
Mailing address
PO Box 400
Wallingford, CT 06492-7048
Phone (203) 284-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00-388689 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622073600000",
"number": "1639102403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 400",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064927048",
"telephone_number": "203-284-2800",
"fax_number": "203-294-8734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 GAYLORD FARM RD",
"city": "WALLINGFORD",
"state": "CT",
"postal_code": "064922899",
"telephone_number": "203-284-2800",
"fax_number": "203-294-8734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAZQUEZ-SANTIAGO",
"first_name": "ROSE",
"middle_name": "I",
"credential": "LCSW,ACSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2021-05-27",
"certification_date": "2021-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CT",
"license": "00-388689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wallingford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.