Provider Demographics
NPI:1912631904
Name:VAZQUEZ VALENTIN, KEYSHLI (BA, RBT)
Entity Type:Individual
Prefix:MRS
First Name:KEYSHLI
Middle Name:
Last Name:VAZQUEZ VALENTIN
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:MRS
Other - First Name:KEYSHLI
Other - Middle Name:
Other - Last Name:VAZQUEZ VALENTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, RBT
Mailing Address - Street 1:49 LINCOLN ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1857
Mailing Address - Country:US
Mailing Address - Phone:774-262-5233
Mailing Address - Fax:
Practice Address - Street 1:900 RIVERDALE ST UNIT 286
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4900
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-22-223873106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician