Provider Demographics
NPI:1023348380
Name:VELAZQUEZ, PATRICIA ALEJANDRA (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ALEJANDRA
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 AVENIDA ALISO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1602
Mailing Address - Country:US
Mailing Address - Phone:505-660-1558
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DRIVE
Practice Address - Street 2:SUITE 302 A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5588
Practice Address - Country:US
Practice Address - Phone:505-660-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2021-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0148551101YP2500X
NMPSY1654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional