Provider Demographics
NPI:1689098543
Name:VELAZQUEZ, KATHERINE ELIZABETH (MPSY)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:Q1 CALLE SANTA LUCIA
Mailing Address - Street 2:URB. SANTA ELVIRA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3440
Mailing Address - Country:US
Mailing Address - Phone:787-533-6833
Mailing Address - Fax:
Practice Address - Street 1:Q1 CALLE SANTA LUCIA
Practice Address - Street 2:URB. SANTA ELVIRA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3440
Practice Address - Country:US
Practice Address - Phone:787-533-6833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005618103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling