Provider Demographics
NPI:1417043936
Name:VELEZ, ANA MERCEDES (MSWLCSWBCD)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MERCEDES
Last Name:VELEZ
Suffix:
Gender:F
Credentials:MSWLCSWBCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 279
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:PA
Mailing Address - Zip Code:18331-0279
Mailing Address - Country:US
Mailing Address - Phone:570-402-1006
Mailing Address - Fax:610-681-3669
Practice Address - Street 1:1023 INERCHANGE ROAD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:PA
Practice Address - Zip Code:18331-0279
Practice Address - Country:US
Practice Address - Phone:570-402-1006
Practice Address - Fax:610-681-8275
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045791-1104100000X
PACW0132291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083979Medicare UPIN