Provider Demographics
NPI:1114396165
Name:BERNICE VAZQUEZ, PSY.D.; LLC
Entity Type:Organization
Organization Name:BERNICE VAZQUEZ, PSY.D.; LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ GARAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:321-430-7017
Mailing Address - Street 1:5728 MAJOR BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7969
Mailing Address - Country:US
Mailing Address - Phone:321-430-7017
Mailing Address - Fax:
Practice Address - Street 1:5728 MAJOR BLVD STE 222
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7969
Practice Address - Country:US
Practice Address - Phone:321-430-7017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841505195OtherNPI