Provider Demographics
NPI:1154916989
Name:CANCEL VAZQUEZ, GIANCARLO (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:GIANCARLO
Middle Name:
Last Name:CANCEL VAZQUEZ
Suffix:
Gender:M
Credentials:PSYD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CALLE MARQUEZ
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3607
Mailing Address - Country:US
Mailing Address - Phone:787-547-2639
Mailing Address - Fax:
Practice Address - Street 1:1760 CALLE LOIZA STE 205
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1867
Practice Address - Country:US
Practice Address - Phone:787-779-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist