Provider Demographics
NPI:1639746647
Name:VELAZQUEZ, LYANNE M (MS)
Entity Type:Individual
Prefix:
First Name:LYANNE
Middle Name:M
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 LAKE SQUARE CIR APT 109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6978
Mailing Address - Country:US
Mailing Address - Phone:787-616-5121
Mailing Address - Fax:
Practice Address - Street 1:12603 LAKE SQUARE CIR APT 109
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-6978
Practice Address - Country:US
Practice Address - Phone:787-616-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health