Provider Demographics
NPI:1245668912
Name:VELASQUEZ, CAROLINE (MSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 MAPLE ST
Mailing Address - Street 2:STE A
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1878
Mailing Address - Country:US
Mailing Address - Phone:231-487-2446
Mailing Address - Fax:888-509-1505
Practice Address - Street 1:126 MAPLE ST
Practice Address - Street 2:STE A
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1878
Practice Address - Country:US
Practice Address - Phone:231-487-2446
Practice Address - Fax:888-509-1505
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010958901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical