Provider Demographics
NPI:1740579499
Name:VELASQUEZ, AMPARO
Entity Type:Individual
Prefix:MS
First Name:AMPARO
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WINTHROP SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1202
Mailing Address - Country:US
Mailing Address - Phone:781-244-5425
Mailing Address - Fax:
Practice Address - Street 1:30 WINTER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4720
Practice Address - Country:US
Practice Address - Phone:617-482-5292
Practice Address - Fax:617-482-5232
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)