Provider Demographics
NPI:1437225471
Name:VELASCO-MAYOCK, LYDIA (MSW LCSW 25817)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:VELASCO-MAYOCK
Suffix:
Gender:F
Credentials:MSW LCSW 25817
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 VICENTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2923
Mailing Address - Country:US
Mailing Address - Phone:415-681-3211
Mailing Address - Fax:415-681-3205
Practice Address - Street 1:1801 VICENTE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:415-681-3211
Practice Address - Fax:415-681-3205
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAASW 13692OtherASSOCIATE CLINICAL SOCIAL