Provider Demographics
NPI:1376815845
Name:VELAZQUEZ CRESPO, MARIVEL (PSYD)
Entity Type:Individual
Prefix:
First Name:MARIVEL
Middle Name:
Last Name:VELAZQUEZ CRESPO
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:PO BOX 34552
Mailing Address - Street 2:
Mailing Address - City:FORT BUCHANAN
Mailing Address - State:PR
Mailing Address - Zip Code:00934-0552
Mailing Address - Country:US
Mailing Address - Phone:787-396-7440
Mailing Address - Fax:
Practice Address - Street 1:CASA LINDA AVE # 177 STREET LOS FILTROS
Practice Address - Street 2:SUITE 101 ENTRANCE MILITARY ACADEMY
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-8998
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR540103TA0400X
PR2706103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)