Provider Demographics
NPI:1124711312
Name:VELAZQUEZ, PRISCILLA (LMSW)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-2797
Mailing Address - Country:US
Mailing Address - Phone:630-546-1760
Mailing Address - Fax:
Practice Address - Street 1:1500 E THOMAS RD STE 106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5748
Practice Address - Country:US
Practice Address - Phone:602-248-6040
Practice Address - Fax:602-279-8957
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-19128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker