Provider Demographics
NPI:1144978743
Name:LAHERA VAZQUEZ, YANELIN
Entity type:Individual
Prefix:
First Name:YANELIN
Middle Name:
Last Name:LAHERA 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 1:3414 SW 8TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5299
Mailing Address - Country:US
Mailing Address - Phone:786-539-8614
Mailing Address - Fax:
Practice Address - Street 1:3414 SW 8TH CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5299
Practice Address - Country:US
Practice Address - Phone:786-539-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 104100000X
FL21-159703106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician