Provider Demographics
NPI:1376737825
Name:VELARDE, MARLENE JOY (LISW)
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:JOY
Last Name:VELARDE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:JOY
Other - Last Name:VIGIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528-0546
Mailing Address - Country:US
Mailing Address - Phone:505-759-3162
Mailing Address - Fax:505-759-3588
Practice Address - Street 1:109 SENECA DRIVE
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528
Practice Address - Country:US
Practice Address - Phone:505-759-3162
Practice Address - Fax:505-759-3588
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-05109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker