Provider Demographics
NPI:1528753258
Name:VAZQUEZ, GRISELL (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:GRISELL
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6221
Mailing Address - Country:US
Mailing Address - Phone:786-863-0061
Mailing Address - Fax:
Practice Address - Street 1:10400 GRIFFIN RD STE 105
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3320
Practice Address - Country:US
Practice Address - Phone:954-837-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health