Provider Demographics
NPI:1780916494
Name:VELAZQUEZ GALLEGO, MARISOL (PSYD)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:VELAZQUEZ GALLEGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 181
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9703
Mailing Address - Country:US
Mailing Address - Phone:787-812-4744
Mailing Address - Fax:
Practice Address - Street 1:HC 8 BOX 181
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-9703
Practice Address - Country:US
Practice Address - Phone:787-812-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3456103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical