Provider Demographics
NPI:1053142307
Name:VELEZ, EMILY IVELYZE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:IVELYZE
Last Name:VELEZ
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 1:7022 NW 63RD ST
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5536
Mailing Address - Country:US
Mailing Address - Phone:954-994-5867
Mailing Address - Fax:
Practice Address - Street 1:4117 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6005
Practice Address - Country:US
Practice Address - Phone:954-652-8613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-364067106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician