Provider Demographics
NPI:1427819853
Name:VELASQUEZ, ERIN MARIBEL
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIBEL
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E BEECH RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2505
Mailing Address - Country:US
Mailing Address - Phone:703-843-4043
Mailing Address - Fax:
Practice Address - Street 1:1205 E BEECH RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2505
Practice Address - Country:US
Practice Address - Phone:703-843-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-23-290098106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician