Provider Demographics
NPI:1104376193
Name:CERQUITELLA, VELNEDIA RENAE (MA)
Entity Type:Individual
Prefix:MRS
First Name:VELNEDIA
Middle Name:RENAE
Last Name:CERQUITELLA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-3019
Mailing Address - Country:US
Mailing Address - Phone:405-246-6440
Mailing Address - Fax:
Practice Address - Street 1:2828 NW 57TH ST
Practice Address - Street 2:STE. 210
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6814
Practice Address - Country:US
Practice Address - Phone:405-246-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician