Healthcare Provider Details

I. General information

NPI: 1285549147
Provider Name (Legal Business Name): MARISOL TEJERA VELAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N HAMILTON ST
POUGHKEEPSIE NY
12601-2541
US

IV. Provider business mailing address

PO BOX 242
GLENHAM NY
12527-0242
US

V. Phone/Fax

Practice location:
  • Phone: 845-452-1110
  • Fax: 845-452-1119
Mailing address:
  • Phone: 857-492-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: