Provider Demographics
NPI:1477842649
Name:VAZQUEZ, ANJANETTE (MA)
Entity Type:Individual
Prefix:
First Name:ANJANETTE
Middle Name:
Last Name:VAZQUEZ
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 1:3013 AVE ALEJANDRINO APT 1302
Mailing Address - Street 2:FONTAINEBLEU PLAZA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7041
Mailing Address - Country:US
Mailing Address - Phone:787-645-1165
Mailing Address - Fax:787-793-8076
Practice Address - Street 1:J5 CALLE CHURCH HL
Practice Address - Street 2:TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-3109
Practice Address - Country:US
Practice Address - Phone:787-645-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist