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General NPI Number Information
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NPI Number | 1215118856
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Entity Type | Individual
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Provider Name | GLORIA YVETTE VELAZQUEZ PHD,LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 3201 HIGHFIELD DR STE C
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City | BETHLEHEM
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State | PA
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Zip | 18020-1113
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Country | US
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Telephone | 610-419-1536
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Fax | 800-556-4985
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Provider Business Mailing Address
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Address Line | 3201 HIGHFIELD DR STE C
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City | BETHLEHEM
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State | PA
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Zip | 18020-1113
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Country | US
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Telephone | 610-419-1536
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Fax | 800-556-4985
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016305
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License Number State | PA
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