Provider Demographics
NPI:1386491157
Name:VELAZQUEZ, MILADYS LEONOR I (RBT)
Entity type:Individual
Prefix:MISS
First Name:MILADYS
Middle Name:LEONOR
Last Name:VELAZQUEZ
Suffix:I
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 NW 198TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1831
Mailing Address - Country:US
Mailing Address - Phone:786-685-5086
Mailing Address - Fax:
Practice Address - Street 1:4335 NW 198TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1831
Practice Address - Country:US
Practice Address - Phone:786-685-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLV422552876850106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician