Provider Demographics
NPI:1962995761
Name:VELEZ, STACEY ANN
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:ANN
Last Name:VELEZ
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 1:125 N WILKES BARRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-5354
Mailing Address - Country:US
Mailing Address - Phone:570-208-4858
Mailing Address - Fax:570-208-4874
Practice Address - Street 1:125 N WILKES BARRE BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-5354
Practice Address - Country:US
Practice Address - Phone:570-208-4858
Practice Address - Fax:570-208-4874
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)