Individual ProviderIvelisse VazquezSocial WorkerBehavioral Health & Social Service ProvidersPractice Address55 Dimock St, Room 266a, Roxbury, MA 02119-1029(617) 442-8800PECOS EnrollmentBased on the most recent information from CMS, provider Ivelisse Vazquez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 12:07 PM.Profile DetailsProvider ID1033446562Provider TypeIndividualFull NameVazquez, IvelisseCredentialMSW, LCSWGenderFemaleSole ProprietorNoEnumeration Date11/4/2009Last Updated11/4/2009Contact InformationPractice LocationPractice Address55 Dimock St, Room 266a, Roxbury, MA 02119-1029Phone(617) 442-8800Fax(617) 541-8472Mailing LocationMailing Address55 Dimock St, Room 266a, Roxbury, MA 02119-1029Phone(617) 442-8800Fax(617) 541-8472Provider TaxonomiesCodeDescriptionLicenseCode1041C0700XPrimaryDescriptionSocial WorkerBehavioral Health & Social Service ProvidersLicense211222Massachusetts