Provider Demographics
NPI:1033451745
Name:VELEZ, JUDY A (PSYD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:VELEZ
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 1:121 CALLE LAJAS
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-8523
Mailing Address - Country:US
Mailing Address - Phone:787-306-1623
Mailing Address - Fax:
Practice Address - Street 1:CARR 100 KM.5.8
Practice Address - Street 2:2DO PISO EDIFICIO GLIDDEN
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-306-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical