Provider Demographics
NPI:1366833675
Name:DENISE A. VAZQUEZ, PSY.D., P.A.
Entity type:Organization
Organization Name:DENISE A. VAZQUEZ, PSY.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-228-5603
Mailing Address - Street 1:1001 N FEDERAL HWY STE 363
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2407
Mailing Address - Country:US
Mailing Address - Phone:954-228-5603
Mailing Address - Fax:954-842-3810
Practice Address - Street 1:1001 N FEDERAL HWY STE 363
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2407
Practice Address - Country:US
Practice Address - Phone:954-228-5603
Practice Address - Fax:954-842-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty