Provider Demographics
NPI:1689019192
Name:VELARDE, DORELY JULIA (BCBA)
Entity Type:Individual
Prefix:MS
First Name:DORELY
Middle Name:JULIA
Last Name:VELARDE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22150 DOGSLED CT # 32
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0020
Mailing Address - Country:US
Mailing Address - Phone:786-678-9495
Mailing Address - Fax:
Practice Address - Street 1:3105 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2815
Practice Address - Country:US
Practice Address - Phone:786-678-9495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-09-6351103K00000X
AK148989103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst