Provider Demographics
NPI:1366058190
Name:VAZQUEZ, SHARLEEN (MA)
Entity type:Individual
Prefix:MRS
First Name:SHARLEEN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 3095
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9647
Mailing Address - Country:US
Mailing Address - Phone:787-212-6920
Mailing Address - Fax:
Practice Address - Street 1:PR 129
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0066
Practice Address - Country:US
Practice Address - Phone:787-212-6920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6713103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling