Provider Demographics
NPI:1477650182
Name:VELAZQUEZ, BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:VELAZQUEZ
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 1:2115 MILLBURN AVE
Mailing Address - Street 2:SUITE 100-3
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3724
Mailing Address - Country:US
Mailing Address - Phone:973-762-6722
Mailing Address - Fax:
Practice Address - Street 1:2115 MILLBURN AVE
Practice Address - Street 2:SUITE 100-3
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3724
Practice Address - Country:US
Practice Address - Phone:973-762-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00402700103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ061934Medicare ID - Type Unspecified