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General NPI Number Information
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NPI Number | 1366833675
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Entity Type | Organization
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Legal Business Name | DENISE A. VAZQUEZ, PSY.D., P.A.
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 1001 N FEDERAL HWY STE 363
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2407
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Country | US
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Telephone | 954-228-5603
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Fax | 954-842-3810
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Provider Business Mailing Address
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Address Line | 1001 N FEDERAL HWY STE 363
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-2407
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Country | US
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Telephone | 954-228-5603
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Fax | 954-842-3810
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE A VAZQUEZ
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Credential | PSY.D.
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Telephone | 954-228-5603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6300
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License Number State | FL
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