Provider Demographics
NPI:1487115689
Name:VELAZQUEZ DAVILA, ARYAM EMMANUEL (MA)
Entity type:Individual
Prefix:
First Name:ARYAM
Middle Name:EMMANUEL
Last Name:VELAZQUEZ DAVILA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P41 CALLE JOSSIE PEREZ
Mailing Address - Street 2:URB VALLE TOLIMA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-462-7268
Mailing Address - Fax:
Practice Address - Street 1:KM 1.5 PR 787
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-462-7268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6005103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist