Provider Demographics
NPI:1467058396
Name:VASQUEZ, MARISA F (RBT,BA)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:F
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:RBT,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1396
Mailing Address - Country:US
Mailing Address - Phone:210-710-0704
Mailing Address - Fax:
Practice Address - Street 1:2000 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4315
Practice Address - Country:US
Practice Address - Phone:210-710-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician