Active NPI
Paola Gomez Velazquez
- Behavior Technician
- Oak Park, IL
National Provider Identifier
1457090219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 6930 Roosevelt Rd
Oak Park, IL 60304-1845 - Phone
- (708) 358-3000
- NPI assigned
- May 31, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
6930 Roosevelt Rd
Oak Park, IL 60304-1845
Mailing address
6417 W Irving Park Rd
Chicago, IL 60634-2437
Phone (773) 777-7112
Other practice location 1
6417 W Irving Park Rd
Chicago, IL 60634-2437
Phone (773) 777-7112
Other practice location 2
6417 W Irving Park Rd
Chicago, IL 60634-2437
Phone (773) 777-7112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth Outreach Services | Past | Accepting new patients | |
| Youth Outreach Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Chicago, IL
- NPI 1659825560
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Chicago, IL
- NPI 1770704579
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718236800000",
"number": "1457090219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6417 W IRVING PARK RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606342437",
"telephone_number": "773-777-7112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6930 ROOSEVELT RD",
"city": "OAK PARK",
"state": "IL",
"postal_code": "603041845",
"telephone_number": "708-358-3000"
}
],
"practiceLocations": [
{
"address_1": "6417 W Irving Park Rd",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606342437",
"country_code": "US",
"telephone_number": "773-777-7112",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6417 W Irving Park Rd",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606342437",
"country_code": "US",
"telephone_number": "773-777-7112",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOMEZ VELAZQUEZ",
"first_name": "PAOLA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-31",
"last_updated": "2024-06-13",
"certification_date": "2024-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.