Provider Demographics
NPI:1447458948
Name:VELAZQUEZ, JOSE R (BS)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:R
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HOME TER
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2959
Mailing Address - Country:US
Mailing Address - Phone:860-478-7770
Mailing Address - Fax:
Practice Address - Street 1:44 HOME TER
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2959
Practice Address - Country:US
Practice Address - Phone:860-478-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker