Healthcare Provider Details

I. General information

NPI: 1972103463
Provider Name (Legal Business Name): ELYZA ANN VELEZ LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

579 COURTLANDT AVE
BRONX NY
10451-5013
US

IV. Provider business mailing address

239 COUNTRY CLUB LN
POMONA NY
10970-2507
US

V. Phone/Fax

Practice location:
  • Phone: 718-485-2100
  • Fax:
Mailing address:
  • Phone: 845-406-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002483-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: