Provider Demographics
NPI:1366452153
Name:VAZQUEZ, MARIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:M
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 KURLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2651
Mailing Address - Country:US
Mailing Address - Phone:508-587-2302
Mailing Address - Fax:
Practice Address - Street 1:169 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3101
Practice Address - Country:US
Practice Address - Phone:781-682-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPY8614-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical