Provider Demographics
NPI:1881928356
Name:VELEZ, DIARA M (MA)
Entity type:Individual
Prefix:MISS
First Name:DIARA
Middle Name:M
Last Name:VELEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST STATION
Mailing Address - State:PR
Mailing Address - Zip Code:00978-0527
Mailing Address - Country:US
Mailing Address - Phone:787-635-1255
Mailing Address - Fax:787-750-4205
Practice Address - Street 1:URB. NUESTRA SRA. DE LOURDES
Practice Address - Street 2:KM 2.0 LOCAL B-24
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-635-1255
Practice Address - Fax:787-750-4205
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3431103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool