Provider Demographics
NPI:1568831600
Name:VELEZ, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 TRAIL RIDGE CT SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-6858
Mailing Address - Country:US
Mailing Address - Phone:321-265-2089
Mailing Address - Fax:
Practice Address - Street 1:2378 TRAIL RIDGE CT SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-6858
Practice Address - Country:US
Practice Address - Phone:321-265-2089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health