Provider Demographics
NPI:1144081977
Name:FIGUEROA VAZQUEZ, EDMARIE
Entity type:Individual
Prefix:
First Name:EDMARIE
Middle Name:
Last Name:FIGUEROA VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOMAS DE TRUJILLO
Mailing Address - Street 2:CALLE 4 C-38
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-4907
Mailing Address - Country:US
Mailing Address - Phone:787-365-0967
Mailing Address - Fax:
Practice Address - Street 1:URB. LOMAS DE TRUJILLO
Practice Address - Street 2:CALLE 4 C-38
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-4907
Practice Address - Country:US
Practice Address - Phone:787-365-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR167571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty