Provider Demographics
NPI:1740761048
Name:VELASQUEZ, ROSANIDIA (BACHELOR'S DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:ROSANIDIA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 62ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1011
Mailing Address - Country:US
Mailing Address - Phone:917-686-6996
Mailing Address - Fax:
Practice Address - Street 1:6202 62ND AVE FL 1
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1011
Practice Address - Country:US
Practice Address - Phone:917-688-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY930220023OtherGHI