Provider Demographics
NPI:1679297345
Name:VELAZQUEZ, LUZMARIE EDIVIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUZMARIE
Middle Name:EDIVIA
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:A18 AVE DEGETAU
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-5836
Mailing Address - Country:US
Mailing Address - Phone:939-745-5500
Mailing Address - Fax:561-944-8003
Practice Address - Street 1:A18 AVE DEGETAU
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-5836
Practice Address - Country:US
Practice Address - Phone:939-745-5500
Practice Address - Fax:561-944-8003
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11927103T00000X
FLPPY336390200000X
PR7764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program