Healthcare Provider Details

I. General information

NPI: 1528593688
Provider Name (Legal Business Name): LISBETH VELEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1560
US

IV. Provider business mailing address

410 AVE HOSTOS SUITE 7
MAYAGUEZ PR
00682-1560
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-831-3714
Mailing address:
  • Phone: 787-833-0663
  • Fax: 787-831-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13346
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number13346
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: