Healthcare Provider Details

I. General information

NPI: 1619384450
Provider Name (Legal Business Name): LETICIA VELIVIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SCHOENERSVILLE RD
BETHLEHEM PA
18017-3574
US

IV. Provider business mailing address

671 HOES LN W
PISCATAWAY NJ
08854-8021
US

V. Phone/Fax

Practice location:
  • Phone: 610-297-7500
  • Fax: 610-297-7533
Mailing address:
  • Phone: 732-235-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA10245000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD4637980
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: