Provider Demographics
NPI:1609562339
Name:PRADO VAZQUEZ, JUDITH VICTORIA (MA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:VICTORIA
Last Name:PRADO 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 1:10671 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1510
Mailing Address - Country:US
Mailing Address - Phone:786-416-0811
Mailing Address - Fax:786-558-5483
Practice Address - Street 1:10671 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1510
Practice Address - Country:US
Practice Address - Phone:786-416-0811
Practice Address - Fax:786-558-5483
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health