Provider Demographics
NPI:1588760755
Name:VELARDE, JOSE RICARDO (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RICARDO
Last Name:VELARDE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 QUENTIN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4245
Mailing Address - Country:US
Mailing Address - Phone:800-275-3243
Mailing Address - Fax:
Practice Address - Street 1:3512 QUENTIN RD STE 110
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4245
Practice Address - Country:US
Practice Address - Phone:800-275-3243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7512103TC0700X
NY020256-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851503Medicaid
NE10025208000Medicaid
NE47052851504Medicaid
NE47052851507Medicaid
NE08242OtherBCBS
NE47052851509Medicaid
NE47052851517Medicaid
NE10025208300Medicaid
NE96011OtherBCBS
NE10025208600Medicaid
NE47052851582Medicaid
NE47052851507Medicaid
NE10025208300Medicaid