| Fvr Psych Intl | |
|
78 Fillmore St Newark NJ 07105-3682 | |
| (862) 372-2737 | |
| Not Available |
| Full Name | Fvr Psych Intl |
|---|---|
| Speciality | Social Worker |
| Location | 78 Fillmore St, Newark, New Jersey |
| Authorized Official Name and Position | Fernando Vazquez (OWNER) |
| Authorized Official Contact | 8623722737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fvr Psych Intl 78 Fillmore St Newark NJ 07105-3682 Ph: (862) 372-2737 | Fvr Psych Intl 78 Fillmore St Newark NJ 07105-3682 Ph: (862) 372-2737 |
| NPI Number | 1194596288 |
|---|---|
| Provider Enumeration Date | 01/09/2024 |
| Last Update Date | 01/10/2024 |
| Certification Date | 01/10/2024 |
| Medicare PECOS PAC ID | 9234651282 |
|---|---|
| Medicare Enrollment ID | O20250319001205 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194596288 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Fernando Vazquez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609333467 PECOS PAC ID: 0143742197 Enrollment ID: I20250319001442 |
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