=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245507391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VELASCO QUINTERO PSYCHOLOGICAL SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 02/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10651 NORTH KENDALL DRIVE. SUITE 120.
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-963-9087
-----------------------------------------------------
Fax | 786-963-9093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10651 NORTH KENDALL DRIVE. SUITE 120.
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33176-1573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-963-9087
-----------------------------------------------------
Fax | 786-963-9093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL COORDINATOR
-----------------------------------------------------
Name | DANIA VELASCO-QUINTERO
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 786-402-8282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH7327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH9459
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------