=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316383847
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEAL VELGOS LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2013
-----------------------------------------------------
Last Update Date | 05/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24511 W JAYNE AVE
-----------------------------------------------------
City | COALINGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-934-8305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 E CINNAMON DR APT 341
-----------------------------------------------------
City | LEMOORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-817-9632
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS29254
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------