Provider Demographics
NPI:1750998357
Name:VELARDE, DONNA D
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:D
Last Name:VELARDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LEE
Other - Last Name:DUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:460 CYPRESS DR APT 6
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1625
Mailing Address - Country:US
Mailing Address - Phone:949-415-8313
Mailing Address - Fax:
Practice Address - Street 1:460 CYPRESS DR APT 6
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-1625
Practice Address - Country:US
Practice Address - Phone:949-415-8313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty