Provider Demographics
NPI:1689433682
Name:VAZQUEZ MORALES, AMARILLIS YADIRA (MA, LPC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:AMARILLIS
Middle Name:YADIRA
Last Name:VAZQUEZ MORALES
Suffix:
Gender:F
Credentials:MA, LPC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6060
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6060
Mailing Address - Country:US
Mailing Address - Phone:787-925-2515
Mailing Address - Fax:
Practice Address - Street 1:950 CARR 189 STE 2
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-5179
Practice Address - Country:US
Practice Address - Phone:787-925-2515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004163101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional