Basic Information
| Provider Information | |||||||||
| NPI: | 1699230847 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VAZQUEZ | ||||||||
| FirstName: | CARMEN | ||||||||
| MiddleName: | MILAGROS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1782 | ||||||||
| Address2: | |||||||||
| City: | CIDRA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007391782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9399699684 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23 CAROLINA CENTURY BUSINESS CENTER CARR 848 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877040705 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2019 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 12832 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.