Provider Demographics
NPI:1902952765
Name:VAZQUEZ-GARCIA, HEIDIE (PHD)
Entity Type:Individual
Prefix:
First Name:HEIDIE
Middle Name:
Last Name:VAZQUEZ-GARCIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05254-0804
Mailing Address - Country:US
Mailing Address - Phone:401-714-8774
Mailing Address - Fax:802-367-1068
Practice Address - Street 1:3855 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05254
Practice Address - Country:US
Practice Address - Phone:802-367-1068
Practice Address - Fax:802-367-1069
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical