MEDICARE: RICKY DINO VELEZ 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC 6242	CO
2	1041C0700X	Clinical Social Worker	70787	TX
3	1041C0700X	Clinical Social Worker	6801119881	MI
4	1041C0700X	Clinical Social Worker	599	CO

General Provider Information

NPI Number	:	1982785325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICKY DINO VELEZ LCSW

Provider Business Mailing Address
First Line	:	7114 DOGWOOD RD
Second Line	:
City	:	LEXINGTON
State	:	MI
Zip	:	48450-8911
Country	:	US
Telephone Number	:	810-824-7922
Fax Number	:	719-988-9702

Provider Business Practice Location Address
First Line	:	1090 S WADSWORTH BLVD UNIT C7012
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-4328
Country	:	US
Telephone Number	:	719-781-2283
Fax Number	:	719-988-9702

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	08/12/2025

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