Provider Demographics
NPI:1245507391
Name:VELASCO QUINTERO PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:VELASCO QUINTERO PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASCO-QUINTERO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:786-402-8282
Mailing Address - Street 1:10651 NORTH KENDALL DRIVE. SUITE 120.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1573
Mailing Address - Country:US
Mailing Address - Phone:786-963-9087
Mailing Address - Fax:786-963-9093
Practice Address - Street 1:10651 NORTH KENDALL DRIVE. SUITE 120.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1573
Practice Address - Country:US
Practice Address - Phone:786-963-9087
Practice Address - Fax:786-963-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7327101YM0800X
FLMH9459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty