MEDICARE: MARISOL VAZQUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1235018441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISOL VAZQUEZ

Provider Business Mailing Address
First Line	:	682 ACADEMY ST APT 33
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-4242
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	682 ACADEMY ST APT 33
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-4242
Country	:	US
Telephone Number	:	347-307-6140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2025
Last Update Date	:	09/01/2025

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Directions to “ MARISOL VAZQUEZ ” Practice Location

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