Active NPI
Kimberly Velazquez, MA, LMHC
- Mental Health Counselor
- East Islip, NY
National Provider Identifier
1336915313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 013980
- Practice address
- 28 Simmons Dr
East Islip, NY 11730-2831 - Phone
- (516) 256-9304
- NPI assigned
- Nov 30, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 013980 | NY | Primary |
Addresses
Primary practice location
28 Simmons Dr
East Islip, NY 11730-2831
Mailing address
28 Simmons Dr
East Islip, NY 11730-2831
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 12, 2024 through Nov 12, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013980 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellqor Psychological Services Northeast, PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Highland Park, NJ
- NPI 1326442567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759708800000",
"number": "1336915313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 SIMMONS DR",
"city": "EAST ISLIP",
"state": "NY",
"postal_code": "117302831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 SIMMONS DR",
"city": "EAST ISLIP",
"state": "NY",
"postal_code": "117302831",
"telephone_number": "516-256-9304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VELAZQUEZ",
"first_name": "KIMBERLY",
"credential": "MA, LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-11-30",
"last_updated": "2025-10-06",
"certification_date": "2025-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "013980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Islip, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.