Provider Demographics
NPI:1205800968
Name:VELEZ, LISA ANN (LMSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:VELEZ
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14987 MILLARD RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8227
Mailing Address - Country:US
Mailing Address - Phone:269-535-0152
Mailing Address - Fax:269-528-4128
Practice Address - Street 1:59478 ROBERTS RD
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9141
Practice Address - Country:US
Practice Address - Phone:269-535-0152
Practice Address - Fax:269-528-4128
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010819191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical