Provider Demographics
NPI:1093740797
Name:VELASQUEZ, AMY ANDERSON (LMFT)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANDERSON
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 G ST # 125-268
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1300
Mailing Address - Country:US
Mailing Address - Phone:209-726-1015
Mailing Address - Fax:209-385-3856
Practice Address - Street 1:368 E YOSEMITE AVE STE 200C
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-9100
Practice Address - Country:US
Practice Address - Phone:209-726-1015
Practice Address - Fax:209-385-3856
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist