Healthcare Provider Details

I. General information

NPI: 1265631337
Provider Name (Legal Business Name): ELDA KANZKI-VELOSO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 SW 8TH ST SUITE 309
MIAMI FL
33144-4400
US

IV. Provider business mailing address

7500 SW 8TH ST SUITE 309
MIAMI FL
33144-4400
US

V. Phone/Fax

Practice location:
  • Phone: 305-742-8826
  • Fax: 305-262-6038
Mailing address:
  • Phone: 305-742-8826
  • Fax: 305-262-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLMHC8406
License Number StateFL

VIII. Authorized Official

Name: DR. ELDA KANZKI VELOSO
Title or Position: PRESIDENT
Credential: PHD
Phone: 304-742-8826