Provider Demographics
NPI:1538879721
Name:VELARDE, ANTHONY PATRICK (LSAA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:PATRICK
Last Name:VELARDE
Suffix:
Gender:M
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 E 20TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2151
Mailing Address - Country:US
Mailing Address - Phone:505-327-0293
Mailing Address - Fax:505-564-4925
Practice Address - Street 1:475 E 20TH ST STE D
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2151
Practice Address - Country:US
Practice Address - Phone:505-327-0293
Practice Address - Fax:505-564-4925
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2022-0917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)