Provider Demographics
NPI:1821790957
Name:SEDA VELEZ, AMBAR NICOLE (MA)
Entity Type:Individual
Prefix:
First Name:AMBAR
Middle Name:NICOLE
Last Name:SEDA VELEZ
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 1:100 AVE. HOSTOS A71
Mailing Address - Street 2:URB. VALLE BELLO CHALETS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5150
Mailing Address - Country:US
Mailing Address - Phone:787-556-4753
Mailing Address - Fax:
Practice Address - Street 1:URB. VALENCIA CALLE CACERES 305-A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-756-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7634103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling