Provider Demographics
NPI:1205110731
Name:VAZQUEZ BERIO, CARMEN TERESA (PSYD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:TERESA
Last Name:VAZQUEZ BERIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 ULMERTON RD
Mailing Address - Street 2:STE12 B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3538
Mailing Address - Country:US
Mailing Address - Phone:727-584-1551
Mailing Address - Fax:727-581-5107
Practice Address - Street 1:10225 ULMERTON RD
Practice Address - Street 2:STE12 B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3538
Practice Address - Country:US
Practice Address - Phone:727-584-1551
Practice Address - Fax:727-581-5107
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist