Provider Demographics
NPI:1437482775
Name:VELAZQUEZ, ILEANA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
Last Name:VELAZQUEZ
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 1:60 OLD NEW MILFORD RD
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2430
Mailing Address - Country:US
Mailing Address - Phone:203-775-5183
Mailing Address - Fax:203-775-8453
Practice Address - Street 1:60 OLD NEW MILFORD RD
Practice Address - Street 2:SUITE 3D
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2430
Practice Address - Country:US
Practice Address - Phone:203-775-5183
Practice Address - Fax:203-775-8453
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0009031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical