Provider Demographics
NPI:1093488249
Name:VELEZ, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:VELEZ
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 1:4 AVIS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2650
Mailing Address - Country:US
Mailing Address - Phone:518-560-4277
Mailing Address - Fax:518-662-4277
Practice Address - Street 1:4 AVIS DR STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2650
Practice Address - Country:US
Practice Address - Phone:518-560-4277
Practice Address - Fax:518-662-4277
Is Sole Proprietor?:No
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111497104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker