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General NPI Number Information
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NPI Number | 1588929178
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Entity Type | Individual
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Provider Name | YESSENIA VELAZQUEZ OTL, MHC
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Gender | Female
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | ST. 111 ISAAC GONZALEZ Y LEDESMA
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City | UTUADO
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State | PR
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Zip | 00641
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Country | US
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Telephone | 787-933-1120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 659
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City | VEGA ALTA
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State | PR
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Zip | 00692-0659
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Country | US
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Telephone | 787-562-1993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2584
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 948
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License Number State | PR
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