Provider Demographics
NPI:1962172205
Name:VAZQUEZ, LILLIAN INES (RBT)
Entity type:Individual
Prefix:MISS
First Name:LILLIAN
Middle Name:INES
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5481 SW 60TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7698
Mailing Address - Country:US
Mailing Address - Phone:352-425-0385
Mailing Address - Fax:
Practice Address - Street 1:5481 SW 60TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7698
Practice Address - Country:US
Practice Address - Phone:352-425-0385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL689103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst