Provider Demographics
NPI:1982972584
Name:VELASQUEZ, STEPHEN (MSW, CISW, LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:MSW, CISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 RUSTIC CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-8820
Mailing Address - Country:US
Mailing Address - Phone:914-768-3026
Mailing Address - Fax:
Practice Address - Street 1:504 RUSTIC CREEK LN
Practice Address - Street 2:
Practice Address - City:CAVE SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72718-8820
Practice Address - Country:US
Practice Address - Phone:914-768-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9830-C1041C0700X
VI0-23249-1B104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical