Provider Demographics
NPI:1063430825
Name:VELEZ, JUDITH (MSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:VELEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CLYDE RD
Mailing Address - Street 2:201
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5040
Mailing Address - Country:US
Mailing Address - Phone:732-873-0736
Mailing Address - Fax:732-873-0736
Practice Address - Street 1:29 CLYDE RD
Practice Address - Street 2:201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5040
Practice Address - Country:US
Practice Address - Phone:732-873-0736
Practice Address - Fax:732-873-0736
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00148600101YM0800X
NYR0187531101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640791Medicare ID - Type Unspecified