Provider Demographics
NPI:1750051587
Name:VAZQUEZ-MALONEY, MARIANA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:
Last Name:VAZQUEZ-MALONEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 N KOLB RD STE 206
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-4933
Mailing Address - Country:US
Mailing Address - Phone:520-214-8650
Mailing Address - Fax:
Practice Address - Street 1:1580 N KOLB RD STE 206
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-4933
Practice Address - Country:US
Practice Address - Phone:520-214-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-17008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional