Provider Demographics
NPI:1417080094
Name:VELASQUEZ, NANCY ESTELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ESTELLA
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12523 BRADLEY AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4691
Mailing Address - Country:US
Mailing Address - Phone:818-744-0095
Mailing Address - Fax:
Practice Address - Street 1:16350 FILBERT ST
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1002
Practice Address - Country:US
Practice Address - Phone:818-364-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA626941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical