Provider Demographics
NPI:1902055023
Name:VELEZ IRIZARRY, JACKELINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JACKELINE
Middle Name:
Last Name:VELEZ IRIZARRY
Suffix:
Gender:F
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:PO BOX 560
Mailing Address - Street 2:MERCEDITA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0560
Mailing Address - Country:US
Mailing Address - Phone:787-598-1949
Mailing Address - Fax:
Practice Address - Street 1:506 COTO LAUREL 102 MARGINAL CARR
Practice Address - Street 2:LEGACY OFFICE PARK SUITE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-813-2222
Practice Address - Fax:787-813-2222
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3176103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical