Healthcare Provider Details

I. General information

NPI: 1982972584
Provider Name (Legal Business Name): STEPHEN VELASQUEZ MSW, CISW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 01/19/2020
Certification Date: 01/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 RUSTIC CREEK LN
CAVE SPRINGS AR
72718-8820
US

IV. Provider business mailing address

504 RUSTIC CREEK LN
CAVE SPRINGS AR
72718-8820
US

V. Phone/Fax

Practice location:
  • Phone: 914-768-6110
  • Fax:
Mailing address:
  • Phone: 914-768-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9830-C
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0-23249-1B
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: