Provider Demographics
NPI:1831333426
Name:VELEZ, NICOLE W
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:W
Last Name:VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:VELEZ
Other - Last Name:ALFONSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:7760 SW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4821
Mailing Address - Country:US
Mailing Address - Phone:786-512-0645
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR
Practice Address - Street 2:SUITE 328
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2708
Practice Address - Country:US
Practice Address - Phone:305-779-8565
Practice Address - Fax:305-779-8564
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH9811OtherLICENSED MENTAL HEALTH COUNSELOR