MEDICARE: MARY J VAZQUEZ LMHC

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265717532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J VAZQUEZ LMHC

Provider Business Mailing Address
First Line	:	9241 LEDGESTONE LN
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-4759
Country	:	US
Telephone Number	:	727-287-8554
Fax Number	:

Provider Business Practice Location Address
First Line	:	6819 JASMINE BLVD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-2123
Country	:	US
Telephone Number	:	727-253-8181
Fax Number	:

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

Provider Enumeration Date	:	10/18/2011
Last Update Date	:	07/21/2022

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