Provider Demographics
NPI:1427111343
Name:VAZQUEZ, IVETTE (MA PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 4278
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9448
Mailing Address - Country:US
Mailing Address - Phone:787-852-6752
Mailing Address - Fax:787-285-8229
Practice Address - Street 1:CALLE MIGUEL CASILLAS NO 50
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792-8990
Practice Address - Country:US
Practice Address - Phone:787-852-6752
Practice Address - Fax:787-285-8229
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist