Healthcare Provider Details

I. General information

NPI: 1437346392
Provider Name (Legal Business Name): NINA ELIZABETH VELEZ LCSW-R, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NINA ELIZABETH VELEZ LCSW-R,CASAC

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 MAIN ST
FISHKILL NY
12524-1790
US

IV. Provider business mailing address

PO BOX 85
WAPPINGERS FALLS NY
12590-0085
US

V. Phone/Fax

Practice location:
  • Phone: 845-202-3539
  • Fax: 845-889-4321
Mailing address:
  • Phone: 845-202-3539
  • Fax: 845-889-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6845
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number070589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: