Provider Demographics
NPI:1437461407
Name:VAZQUEZ - VELAZQUEZ, MARITZA (MA)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:
Last Name:VAZQUEZ - VELAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CALLE VALCARCEL APT 4K
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3340
Mailing Address - Country:US
Mailing Address - Phone:787-316-2013
Mailing Address - Fax:
Practice Address - Street 1:1007 AVE MUNOZ RIVERA EDIFICIO DARLINGTON
Practice Address - Street 2:OFICINA 902
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-316-2013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical