Provider Demographics
NPI:1417177585
Name:VELEZ, SIMON (ICM)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:ICM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RIVERSIDE DR APT 55
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7631
Mailing Address - Country:US
Mailing Address - Phone:212-694-3500
Mailing Address - Fax:212-694-4998
Practice Address - Street 1:215-217 WEST 135 STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:212-694-3500
Practice Address - Fax:212-694-4998
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker