Provider Demographics
NPI:1477782373
Name:VAZQUEZ, LISA MARIE BARTSCH (MFT-780)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE BARTSCH
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MFT-780
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BARTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:76-1012 MAMALAHOA HWY
Mailing Address - Street 2:
Mailing Address - City:HOLUALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96725
Mailing Address - Country:US
Mailing Address - Phone:650-740-8073
Mailing Address - Fax:
Practice Address - Street 1:76-1012 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:HOLUALOA
Practice Address - State:HI
Practice Address - Zip Code:96725
Practice Address - Country:US
Practice Address - Phone:650-740-8073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47297106H00000X
HIMFT-780106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist