Provider Demographics
NPI:1497289060
Name:VAZQUEZ MARRERO, BLANCA
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:
Last Name:VAZQUEZ MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:U4 CONDOMINIO VILLAS DE PLAYA 2
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-6535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:313 AVENIDA DOMENECH
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-398-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5887103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling