Provider Demographics
NPI:1871729251
Name:VASQUEZ-COLEMAN, GILLIAN JANINE
Entity type:Individual
Prefix:MRS
First Name:GILLIAN
Middle Name:JANINE
Last Name:VASQUEZ-COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GILLIAN
Other - Middle Name:JANINE
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:456 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-6121
Mailing Address - Country:US
Mailing Address - Phone:860-343-0012
Mailing Address - Fax:860-343-0076
Practice Address - Street 1:91 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1534
Practice Address - Country:US
Practice Address - Phone:860-632-3231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-30
Last Update Date:2009-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker