Provider Demographics
NPI:1265585772
Name:VAZQUEZ, WILLIAM A (PSYD; MSW)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PSYD; MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14127 SANCTUARY TERRACE LN UNIT 24-100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6643
Mailing Address - Country:US
Mailing Address - Phone:407-408-6198
Mailing Address - Fax:
Practice Address - Street 1:5201 RAYMOND ST RM 432
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-8208
Practice Address - Country:US
Practice Address - Phone:407-646-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR8480104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program