Provider Demographics
NPI:1962567057
Name:VELETZA, LOUISA (EDD)
Entity type:Individual
Prefix:DR
First Name:LOUISA
Middle Name:
Last Name:VELETZA
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HENSHAW ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-2905
Mailing Address - Country:US
Mailing Address - Phone:617-562-0705
Mailing Address - Fax:
Practice Address - Street 1:17 HENSHAW ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-2905
Practice Address - Country:US
Practice Address - Phone:617-562-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC4380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health