Provider Demographics
NPI:1619384450
Name:VELIVIS, LETICIA (MD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:
Last Name:VELIVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HOES LN W
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8021
Mailing Address - Country:US
Mailing Address - Phone:732-235-4433
Mailing Address - Fax:
Practice Address - Street 1:2710 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3574
Practice Address - Country:US
Practice Address - Phone:610-297-7500
Practice Address - Fax:610-297-7533
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA102450002084P0800X
PAMD46379802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry