Provider Demographics
NPI:1588953863
Name:VELASQUEZ, LENY DE VALLE (BS, BCABA)
Entity type:Individual
Prefix:MS
First Name:LENY
Middle Name:DE VALLE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SAINT JOHNS STREET
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922
Mailing Address - Country:US
Mailing Address - Phone:321-639-9800
Mailing Address - Fax:321-639-6007
Practice Address - Street 1:550 SAINT JOHNS STREET
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922
Practice Address - Country:US
Practice Address - Phone:321-639-9800
Practice Address - Fax:321-639-6007
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCABA CERT#0-11-4057103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst