Provider Demographics
NPI:1730567405
Name:VELASQUEZ, MEREDITH SUZANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SUZANNE
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:SUZANNE
Other - Last Name:SLOCUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9700 E EASTER LN
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1136
Mailing Address - Country:US
Mailing Address - Phone:720-213-1320
Mailing Address - Fax:
Practice Address - Street 1:9700 E EASTER LN
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1136
Practice Address - Country:US
Practice Address - Phone:720-213-1324
Practice Address - Fax:720-213-1324
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO897101YA0400X
CO99248531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)