Provider Demographics
NPI:1154947562
Name:VELASCO, MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VELASCO
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 1:2617 E LINCOLNWAY STE G
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5671
Mailing Address - Country:US
Mailing Address - Phone:307-286-0921
Mailing Address - Fax:
Practice Address - Street 1:2617 E LINCOLNWAY STE G
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5671
Practice Address - Country:US
Practice Address - Phone:307-286-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-17181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY156171500Medicaid