Provider Demographics
NPI:1700088812
Name:VAZQUEZ-PAUSA, ANTONIO MIGUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:MIGUEL
Last Name:VAZQUEZ-PAUSA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5751
Mailing Address - Country:US
Mailing Address - Phone:305-788-4590
Mailing Address - Fax:
Practice Address - Street 1:9350 SW 72ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3245
Practice Address - Country:US
Practice Address - Phone:305-595-2590
Practice Address - Fax:305-595-3746
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3712101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health