Provider Demographics
NPI:1851907240
Name:VELASQUEZ, SUSAN YANIRA (LMSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:YANIRA
Last Name:VELASQUEZ
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 1:55 W AMES CT
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-2304
Mailing Address - Country:US
Mailing Address - Phone:516-318-0281
Mailing Address - Fax:
Practice Address - Street 1:55 W AMES CT
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-2304
Practice Address - Country:US
Practice Address - Phone:516-318-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108801104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker