Provider Demographics
NPI:1114563772
Name:FARIAS, VRITSY
Entity Type:Individual
Prefix:
First Name:VRITSY
Middle Name:
Last Name:FARIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S AW GRIMES BLVD
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-7429
Mailing Address - Country:US
Mailing Address - Phone:512-401-3612
Mailing Address - Fax:512-717-5553
Practice Address - Street 1:1250 S AW GRIMES BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7429
Practice Address - Country:US
Practice Address - Phone:512-401-3612
Practice Address - Fax:512-717-5553
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19103419106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician