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NPI Code Detail

MEDICARE: SUSANA MICHELLE VAZQUEZ NIEVES PSYD

MEDICARE: SUSANA MICHELLE VAZQUEZ NIEVES PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2390200000XStudent in an Organized Health Care Education/Training Program
3103T00000XPsychologistPY9861FL

General Provider Information

NPI Number : 1083953434
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSANA MICHELLE VAZQUEZ NIEVES PSYD
Provider Business Mailing Address
First Line : PO BOX 1137
Second Line :
City : MELBOURNE
State : FL
Zip : 32902-1137
Country : US
Telephone Number : 321-952-9696
Fax Number : 321-952-7937
Provider Business Practice Location Address
First Line : 5270 BABCOCK ST NE STE 1
Second Line :
City : PALM BAY
State : FL
Zip : 32905-4616
Country : US
Telephone Number : 321-722-6301
Fax Number : 321-722-5960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2013
Last Update Date : 03/17/2018

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Directions to “ SUSANA MICHELLE VAZQUEZ NIEVES PSYD” Practice Location

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