MEDICARE: DR. MELISSA VELAZQUEZ RUIZ PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	003322	PR

General Provider Information

NPI Number	:	1356572606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA VELAZQUEZ RUIZ PSYD

Provider Business Mailing Address
First Line	:	7005 SHORE RD APT 3G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1030
Country	:	US
Telephone Number	:	646-275-7670
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 SHORE RD APT 3G
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1030
Country	:	US
Telephone Number	:	646-275-7670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	08/04/2009

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