Provider Demographics
NPI:1669894572
Name:VELASCO, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 AUZERAIS AVE
Mailing Address - Street 2:UNIT 304
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3536
Mailing Address - Country:US
Mailing Address - Phone:267-476-9026
Mailing Address - Fax:
Practice Address - Street 1:2680 S WHITE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2074
Practice Address - Country:US
Practice Address - Phone:408-755-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-11
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW699451041C0700X
CAASW354371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical