Provider Demographics
NPI:1962640003
Name:VAZQUEZ, DENISE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N FEDERAL HWY STE 363
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2407
Mailing Address - Country:US
Mailing Address - Phone:954-228-5603
Mailing Address - Fax:
Practice Address - Street 1:1001 NORTH FEDERAL HIGHWAY SUITE 363
Practice Address - Street 2:
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-2407
Practice Address - Country:US
Practice Address - Phone:954-228-5603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766810400Medicaid