Basic Information
| Provider Information | |||||||||
| NPI: | 1669894572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELASCO | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHMIDT | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 809 AUZERAIS AVE | ||||||||
| Address2: | UNIT 304 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951263536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2674769026 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2680 S WHITE RD | ||||||||
| Address2: | SUITE 170 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951482074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087553905 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2014 | ||||||||
| LastUpdateDate: | 01/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW69945 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | ASW35437 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.