MEDICARE: REBECCA VELASQUEZ, LICENSED CLINICAL SOCIAL WORKER & ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730060039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REBECCA VELASQUEZ, LICENSED CLINICAL SOCIAL WORKER & ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	486 MARSH ST STE A
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3894
Country	:	US
Telephone Number	:	805-305-4543
Fax Number	:

Provider Business Practice Location Address
First Line	:	486 MARSH ST STE A
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-3894
Country	:	US
Telephone Number	:	805-305-4543
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	MRS. REBECCA VELASQUEZ
Credential	:	LCSW
Telephone Number	:	805-305-4543

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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