Basic Information
Provider Information | |||||||||
NPI: | 1689000630 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAY | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | VELEZ | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VELEZ | ||||||||
OtherFirstName: | STEPHANIE | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1241 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228024632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404341941 | ||||||||
FaxNumber: | 5404326989 | ||||||||
Practice Location | |||||||||
Address1: | 463 E WASHINGTON ST | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228024853 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404333100 | ||||||||
FaxNumber: | 5404326989 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/23/2013 | ||||||||
LastUpdateDate: | 05/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW130555 | PA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | 0904009663 | VA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.