Provider Demographics
NPI:1134918311
Name:ROGERS-VAZQUEZ, AUTUMN D (RCSWI)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:D
Last Name:ROGERS-VAZQUEZ
Suffix:
Gender:
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S CYPRESS RD APT 117
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7084
Mailing Address - Country:US
Mailing Address - Phone:201-566-3336
Mailing Address - Fax:
Practice Address - Street 1:3000 NW 101ST LN UNIT 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3930
Practice Address - Country:US
Practice Address - Phone:201-566-3336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW163331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical