Provider Demographics
NPI:1063731859
Name:VAZQUEZ, CARMENE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:CARMENE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NE 183RD ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2100
Mailing Address - Country:US
Mailing Address - Phone:305-931-3845
Mailing Address - Fax:
Practice Address - Street 1:1065 NE 125TH ST
Practice Address - Street 2:STE 206
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5821
Practice Address - Country:US
Practice Address - Phone:888-852-6672
Practice Address - Fax:305-891-4228
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002667200Medicaid