Provider Demographics
NPI:1114266830
Name:VAZQUEZ CANIDATE, AIDA M (MA LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:M
Last Name:VAZQUEZ CANIDATE
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MRS
Other - First Name:AIDA
Other - Middle Name:M
Other - Last Name:VAZQUEZ CANIDATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:100 PEARL ST FL 14
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-4500
Mailing Address - Country:US
Mailing Address - Phone:860-951-4130
Mailing Address - Fax:
Practice Address - Street 1:100 PEARL ST FL 14
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-4500
Practice Address - Country:US
Practice Address - Phone:860-951-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CT27.001949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist