Provider Demographics
NPI:1679793731
Name:VELAZQUEZ, ENID (MS)
Entity type:Individual
Prefix:PROF
First Name:ENID
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDINES DE CERRO GORDO ST 4 B 5
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00754 4507
Mailing Address - Country:UM
Mailing Address - Phone:787-635-8519
Mailing Address - Fax:787-736-7805
Practice Address - Street 1:LC INSURANCE BUILDING
Practice Address - Street 2:CARR 183 KM 10.4 BO QUEMADOS
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-4507
Practice Address - Country:US
Practice Address - Phone:787-635-8519
Practice Address - Fax:787-736-7805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical