MEDICARE: MRS. LISANDRA VELEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114332871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISANDRA VELEZ

Provider Business Mailing Address
First Line	:	1236 S BEACH CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 S BEACH CIR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-6746
Country	:	US
Telephone Number	:	407-508-5132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2014
Last Update Date	:	06/20/2014

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