Provider Demographics
NPI:1326781097
Name:FELICIANO VELEZ, ESTHER MARIE (MSC)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:MARIE
Last Name:FELICIANO VELEZ
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 RUTA 474
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-4007
Mailing Address - Country:US
Mailing Address - Phone:939-242-8170
Mailing Address - Fax:
Practice Address - Street 1:289 RUTA 474
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4007
Practice Address - Country:US
Practice Address - Phone:939-242-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6642103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NON-MEDICAREOtherNON-MEDICARE