Healthcare Provider Details

I. General information

NPI: 1366452153
Provider Name (Legal Business Name): MARIA M VAZQUEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 03/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 LIBBEY INDUSTRIAL PKWY 2ND FLOOR
WEYMOUTH MA
02189-3101
US

IV. Provider business mailing address

36 KURLAND AVE
BROCKTON MA
02301-2651
US

V. Phone/Fax

Practice location:
  • Phone: 781-682-1060
  • Fax:
Mailing address:
  • Phone: 508-587-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8614-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: