Healthcare Provider Details

I. General information

NPI: 1811348188
Provider Name (Legal Business Name): STEPHANIE MARIE RIVERA VELAZQUEZ EDD, NCC, LMHC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 SARATOGA INLET DR
ORLANDO FL
32829-8376
US

IV. Provider business mailing address

8501 SARATOGA INLET DR
ORLANDO FL
32829-8376
US

V. Phone/Fax

Practice location:
  • Phone: 407-706-7162
  • Fax:
Mailing address:
  • Phone: 787-469-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH15564
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3713
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT2652
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH16787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: