Provider Demographics
NPI:1023851375
Name:VELEZ, DAVID DANIEL (RBT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DANIEL
Last Name:VELEZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:DANIEL
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1855 NW CATALUNA CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-5803
Mailing Address - Country:US
Mailing Address - Phone:772-667-0642
Mailing Address - Fax:
Practice Address - Street 1:8103 INDRIO RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-1609
Practice Address - Country:US
Practice Address - Phone:772-667-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1091900106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician