Provider Demographics
NPI:1124244074
Name:VELAZQUEZ, LETICIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:LETICIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 UNIVERSITY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1690
Mailing Address - Country:US
Mailing Address - Phone:858-966-5484
Mailing Address - Fax:619-795-1228
Practice Address - Street 1:3020 CHILDRENS WAY # MC6038
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5484
Practice Address - Fax:619-795-1228
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW595561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical