Provider Demographics
NPI:1699230847
Name:VAZQUEZ, CARMEN MILAGROS SR (MSW)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MILAGROS
Last Name:VAZQUEZ
Suffix:SR
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1782
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1782
Mailing Address - Country:US
Mailing Address - Phone:939-969-9684
Mailing Address - Fax:
Practice Address - Street 1:23 CAROLINA CENTURY BUSINESS CENTER CARR 848
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-704-0705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR128321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical