Healthcare Provider Details

I. General information

NPI: 1104645241
Provider Name (Legal Business Name): PEDRO VELAZQUEZ MASTER SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 LINWOOD ST # 1949
NEW BRITAIN CT
06052-1998
US

IV. Provider business mailing address

31 BANNISTER ST
HARTFORD CT
06106-3509
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-9113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: