Provider Demographics
NPI:1558430017
Name:VELETA, MARY (MSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VELETA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 E ORANGE GROVE BLVD APT 5
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-3000
Mailing Address - Country:US
Mailing Address - Phone:626-310-0717
Mailing Address - Fax:
Practice Address - Street 1:5321 VIA MARISOL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4883
Practice Address - Country:US
Practice Address - Phone:323-478-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical