Provider Demographics
NPI:1245035088
Name:VAZQUEZ ACOSTA, MAYLIN
Entity type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:VAZQUEZ ACOSTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 ROUNDROCK DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-3445
Mailing Address - Country:US
Mailing Address - Phone:817-724-3633
Mailing Address - Fax:
Practice Address - Street 1:1070 ROUNDROCK DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-3445
Practice Address - Country:US
Practice Address - Phone:817-724-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty