Provider Demographics
NPI:1659971679
Name:VELASQUEZ, SADITH MARISCAL (ACSW)
Entity type:Individual
Prefix:
First Name:SADITH
Middle Name:MARISCAL
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 GEER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-3311
Mailing Address - Country:US
Mailing Address - Phone:209-633-3057
Mailing Address - Fax:209-633-3031
Practice Address - Street 1:875 GEER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3311
Practice Address - Country:US
Practice Address - Phone:209-633-3057
Practice Address - Fax:209-633-3031
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAACSW1094771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical