Provider Demographics
NPI:1407002512
Name:VELASQUEZ, ENRIQUE AUGUSTO (LCSW)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:AUGUSTO
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 E 1500 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-2134
Mailing Address - Country:US
Mailing Address - Phone:801-643-1640
Mailing Address - Fax:801-233-8682
Practice Address - Street 1:8541 S REDWOOD RD
Practice Address - Street 2:BLDG A
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9327
Practice Address - Country:US
Practice Address - Phone:801-233-8670
Practice Address - Fax:801-233-8682
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133485-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical