Provider Demographics
NPI:1932515806
Name:VELASQUEZ, ISABEL (PSYD)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12641 WORLD PLAZA LN UNIT 56
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3990
Mailing Address - Country:US
Mailing Address - Phone:239-247-1756
Mailing Address - Fax:239-690-2438
Practice Address - Street 1:12641 WORLD PLAZA LN UNIT 56
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3990
Practice Address - Country:US
Practice Address - Phone:239-247-1756
Practice Address - Fax:239-690-2438
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12028103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist