Provider Demographics
NPI:1821201625
Name:GARCIA - VELASCO, DEICY (CMHP-CAPP-CAC)
Entity Type:Individual
Prefix:
First Name:DEICY
Middle Name:
Last Name:GARCIA - VELASCO
Suffix:
Gender:F
Credentials:CMHP-CAPP-CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 S.W.40 STREET
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-491-6689
Mailing Address - Fax:
Practice Address - Street 1:9380 S.W. 72 ST.
Practice Address - Street 2:SUITE B- 120
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5454
Practice Address - Country:US
Practice Address - Phone:305-274-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50450101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health