Provider Demographics
NPI:1821599127
Name:VELAZQUEZ, KYISHA KIA (MA)
Entity Type:Individual
Prefix:
First Name:KYISHA
Middle Name:KIA
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 NORTON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2829
Mailing Address - Country:US
Mailing Address - Phone:203-903-8684
Mailing Address - Fax:
Practice Address - Street 1:446A BLAKE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-0651
Practice Address - Country:US
Practice Address - Phone:203-387-9400
Practice Address - Fax:203-387-9400
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health