Provider Demographics
NPI:1598401697
Name:VELAZQUEZ PICHARDO, GLORIMAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLORIMAR
Middle Name:
Last Name:VELAZQUEZ PICHARDO
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 1:1605 AVE PONCE DE LEON
Mailing Address - Street 2:EDIFICIOS SAN MARTIN SUITE 100
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 AVE PONCE DE LEON, EDIFICIOS SAN MARTIN
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-633-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6094OtherPRIVATE