Provider Demographics
NPI:1124831011
Name:VELASQUEZ, KAROL TATIANA
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:TATIANA
Last Name:VELASQUEZ
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 1:1003 FLOWER ST NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-7746
Mailing Address - Country:US
Mailing Address - Phone:689-224-2723
Mailing Address - Fax:
Practice Address - Street 1:1003 FLOWER ST NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-7746
Practice Address - Country:US
Practice Address - Phone:689-224-2723
Practice Address - Fax:689-224-2723
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist