MEDICARE: MS. JENNIFER MARIE VELASQUEZ LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	91471	CA

General Provider Information

NPI Number	:	1316388671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER MARIE VELASQUEZ LCSW

Provider Business Mailing Address
First Line	:	8744 RILEY AVE
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92344-8312
Country	:	US
Telephone Number	:	626-374-4375
Fax Number	:

Provider Business Practice Location Address
First Line	:	8744 RILEY AVE
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92344-8312
Country	:	US
Telephone Number	:	626-374-4375
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	09/30/2020

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