Provider Demographics
NPI:1174646905
Name:VELEZ-MORALES, MYRIAM (MA)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:VELEZ-MORALES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2291
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 BLVD ALFONSO VALDES
Practice Address - Street 2:HEALTH SERVICES DEPARTMENT RUM
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-6475
Practice Address - Country:US
Practice Address - Phone:787-832-4040
Practice Address - Fax:787-834-1538
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist