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General NPI Number Information
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NPI Number | 1265717532
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Entity Type | Individual
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Provider Name | MARY J VAZQUEZ LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6819 JASMINE BLVD
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City | PORT RICHEY
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State | FL
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Zip | 34668-2123
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Country | US
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Telephone | 727-253-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 9241 LEDGESTONE LN
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City | PORT RICHEY
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State | FL
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Zip | 34668-4759
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Country | US
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Telephone | 727-287-8554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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