Provider Demographics
NPI:1275502353
Name:VELEZ, GLENDA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:L
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15422 CALLE FLAMBOYAN
Mailing Address - Street 2:PASEO JACARANDA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9621
Mailing Address - Country:US
Mailing Address - Phone:787-632-1179
Mailing Address - Fax:
Practice Address - Street 1:124 CALLE JOSE I QUINTON
Practice Address - Street 2:SUITE 7
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3050
Practice Address - Country:US
Practice Address - Phone:787-632-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2158103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical