Healthcare Provider Details

I. General information

NPI: 1265585772
Provider Name (Legal Business Name): WILLIAM A VAZQUEZ PSY.D; MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST RM 432
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

14127 SANCTUARY TERRACE LN UNIT 24-100
ORLANDO FL
32832-6643
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5500
  • Fax:
Mailing address:
  • Phone: 407-408-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8480
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: