Provider Demographics
NPI:1275593329
Name:VELEZ, MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
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 1:180 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2212
Mailing Address - Country:US
Mailing Address - Phone:718-496-2284
Mailing Address - Fax:
Practice Address - Street 1:517 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3608
Practice Address - Country:US
Practice Address - Phone:718-496-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012446103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02358721Medicaid
NYVL9931Medicare PIN
P83315Medicare UPIN