Provider Demographics
NPI:1679816722
Name:VELEZ, IVELISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IVELISE
Middle Name:
Last Name:VELEZ
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 1:582 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6608
Mailing Address - Country:US
Mailing Address - Phone:201-208-8089
Mailing Address - Fax:
Practice Address - Street 1:560 HUDSON ST
Practice Address - Street 2:3-2
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6655
Practice Address - Country:US
Practice Address - Phone:201-208-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055375001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical