Provider Demographics
NPI:1487302618
Name:VELAZCO, ALISON
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:VELAZCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10985 SW 107TH ST APT 311
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3379
Mailing Address - Country:US
Mailing Address - Phone:786-512-0488
Mailing Address - Fax:
Practice Address - Street 1:10985 SW 107TH ST APT 311
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3379
Practice Address - Country:US
Practice Address - Phone:786-512-0488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123915106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108269900Medicaid