Healthcare Provider Details

I. General information

NPI: 1609422120
Provider Name (Legal Business Name): DANIELLE VELAZQUEZ LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 STEWART AVE STE 700
GARDEN CITY NY
11530-4785
US

IV. Provider business mailing address

585 STEWART AVE STE 700
GARDEN CITY NY
11530-4785
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-7285
  • Fax:
Mailing address:
  • Phone: 516-280-7825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001244-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: