Provider Demographics
NPI:1922683309
Name:VELEZ, KATHLEEN YAELLE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:YAELLE
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11522 SW 13TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4811
Mailing Address - Country:US
Mailing Address - Phone:305-988-8411
Mailing Address - Fax:
Practice Address - Street 1:11522 SW 13TH CT
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4811
Practice Address - Country:US
Practice Address - Phone:305-988-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician