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General NPI Number Information
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NPI Number | 1801231147
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Entity Type | Individual
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Provider Name | MARIA ELENA VELASCO FONTAINE MS
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Gender | Female
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 6152 DELANCEY STATION ST STE 206
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City | RIVERVIEW
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State | FL
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Zip | 33578-4206
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Country | US
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Telephone | 813-285-7524
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Fax |
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Provider Business Mailing Address
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Address Line | 2908 AMBER OAK DR
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City | VALRICO
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State | FL
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Zip | 33594-6740
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Country | US
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Telephone | 813-472-6893
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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 | MH13552
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH10933
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License Number State | FL
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