Healthcare Provider Details

I. General information

NPI: 1669296901
Provider Name (Legal Business Name): YAMARIS VAZQUEZ GARCIA PSYD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CALLE SARGENTO ISRAEL MALARET JUARBE
UTUADO PR
00641
US

IV. Provider business mailing address

HC 1 BOX 8019
HATILLO PR
00659-7358
US

V. Phone/Fax

Practice location:
  • Phone: 939-272-6658
  • Fax:
Mailing address:
  • Phone: 939-272-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14087
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8310
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: