Provider Demographics
NPI:1255095816
Name:VELAZQUEZ, CIDMARIE (MSED)
Entity type:Individual
Prefix:
First Name:CIDMARIE
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:CID MARIE
Other - Middle Name:
Other - Last Name:ROSARIO QUINONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:78 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3013
Mailing Address - Country:US
Mailing Address - Phone:646-620-3684
Mailing Address - Fax:
Practice Address - Street 1:120 N MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3743
Practice Address - Country:US
Practice Address - Phone:845-638-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4025636252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency