Individual
SUSANA MICHELLE VAZQUEZ NIEVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
5270 BABCOCK ST NE STE 1, PALM BAY, FL 32905-4616
(321) 722-6301
(321) 722-5960
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
PY9861
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/05/2013
Last updated
03/17/2018
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