Healthcare Provider Details

I. General information

NPI: 1689439770
Provider Name (Legal Business Name): ANGEL MANUEL MUNOZ-VELAZQUEZ LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 MAIN ST
GLASTONBURY CT
06033-4231
US

IV. Provider business mailing address

41 E MAIN ST FL 2
TORRINGTON CT
06790-5425
US

V. Phone/Fax

Practice location:
  • Phone: 860-470-4726
  • Fax:
Mailing address:
  • Phone: 860-470-4726
  • Fax: 203-717-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9098
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: