Provider Demographics
NPI:1437346392
Name:VELEZ, NINA ELIZABETH (LCSW-R, CASAC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ELIZABETH
Last Name:VELEZ
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:ELIZABETH
Other - Last Name:VELEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R,CASAC
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-0085
Mailing Address - Country:US
Mailing Address - Phone:845-202-3539
Mailing Address - Fax:845-889-4321
Practice Address - Street 1:997 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1790
Practice Address - Country:US
Practice Address - Phone:845-202-3539
Practice Address - Fax:845-889-4321
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0705891041C0700X
NY6845101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY876541L271Medicare PIN