Provider Demographics
NPI:1477148716
Name:VAZQUEZ, ALYSSA (LMFT)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 SW 78TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7540
Mailing Address - Country:US
Mailing Address - Phone:414-416-6275
Mailing Address - Fax:
Practice Address - Street 1:4601 PONCE DE LEON BLVD STE 260
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2110
Practice Address - Country:US
Practice Address - Phone:305-846-9370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3821106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist