Provider Demographics
NPI:1457880882
Name:VELEZ, BRENDALY (PSIC)
Entity Type:Individual
Prefix:
First Name:BRENDALY
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:PSIC
Other - Prefix:MRS
Other - First Name:BRENDALY
Other - Middle Name:
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CERRO MORALES ST. LOMAS DE CAROLINA
Mailing Address - Street 2:R-10
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-473-4665
Mailing Address - Fax:
Practice Address - Street 1:90 CALLE ANTONIO GIMENEZ LANDRAU
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-944-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5891103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist