Provider Demographics
NPI:1023412236
Name:VELEZ, JESICA CHRISTINE
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:CHRISTINE
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 1:911 E ATLANTIC BLVD STE 108A
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7372
Mailing Address - Country:US
Mailing Address - Phone:786-262-5953
Mailing Address - Fax:
Practice Address - Street 1:911 EAST ATLANTIC BULEVARD #108A
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060
Practice Address - Country:US
Practice Address - Phone:954-941-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-1830460103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst