Provider Demographics
NPI:1902982895
Name:VELASQUEZ, SONIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 2ND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3860
Mailing Address - Country:US
Mailing Address - Phone:650-344-8080
Mailing Address - Fax:
Practice Address - Street 1:126 2ND AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3860
Practice Address - Country:US
Practice Address - Phone:650-344-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist