Healthcare Provider Details

I. General information

NPI: 1992373567
Provider Name (Legal Business Name): AMANDA VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BIRMINGHAM RD
PEMBERTON NJ
08068-1326
US

IV. Provider business mailing address

300 BIRMINGHAM RD
PEMBERTON NJ
08068-1326
US

V. Phone/Fax

Practice location:
  • Phone: 609-288-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: