Provider Demographics
NPI:1700333572
Name:VELASCO, COLLEEN T (ASW)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:T
Last Name:VELASCO
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:THACKER
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17800 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7079
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:562-461-2893
Practice Address - Street 1:17800 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7079
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:562-461-2893
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW664521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical