Provider Demographics
NPI:1922839422
Name:VAZQUEZ, MELVIN (LADC II)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:LADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-3306
Mailing Address - Country:US
Mailing Address - Phone:781-842-7261
Mailing Address - Fax:
Practice Address - Street 1:36 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-3306
Practice Address - Country:US
Practice Address - Phone:781-842-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2116101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)