MEDICARE: DR. MARITZA VELEZ PSY.D

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	002375	PR

General Provider Information

NPI Number	:	1508067844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARITZA VELEZ PSY.D

Provider Business Mailing Address
First Line	:	30 CALLE NUEVA
Second Line	:	BO. ANCONES
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4244
Country	:	US
Telephone Number	:	787-210-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 CALLE NUEVA
Second Line	:	BO. ANCONES
City	:	SAN GERMAN
State	:	PR
Zip	:	00683-4244
Country	:	US
Telephone Number	:	787-210-5577
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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