Provider Demographics
NPI:1790168359
Name:IVELISE VELEZ CORPORATION
Entity Type:Organization
Organization Name:IVELISE VELEZ CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVELISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-208-8089
Mailing Address - Street 1:560 HUDSON STREET
Mailing Address - Street 2:SUITE3 ROOM 2
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-208-8089
Mailing Address - Fax:201-440-5204
Practice Address - Street 1:560 HUDSON STREET
Practice Address - Street 2:SUITE3 ROOM 2
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-208-8089
Practice Address - Fax:201-440-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05537500251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health