Kimberley Lorraine Velazquez, MSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

39900 Issued in ID

Practice address

110 Granite Ridge Dr
Sandpoint, ID 83864-7069

Phone

(253) 304-1565

NPI assigned

Apr 20, 2015

Reactivated

Apr 14, 2022

Last updated

Oct 10, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1639566458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 GRANITE RIDGE DR",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838647069",
            "telephone_number": "253-304-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 GRANITE RIDGE DR",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838647069",
            "telephone_number": "253-304-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELAZQUEZ",
        "first_name": "KIMBERLEY",
        "middle_name": "LORRAINE",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-20",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "deactivation_date": "2016-04-04",
        "reactivation_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "39900",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Cory Van Den Berg, DC
• Christian Vanderford, PT
• Echo T Vanderwal, PA
• Harry Ralph Vanderwal Jr., MD
• Joseph Anthony Velazquez, LMFT
• Henry L Verdugo, LCSW
• Viva Enterprises (Sandpoint Optometry & Thomas M Wiley OD)
• Andrew Benjamin Vizcarra, M.D.
• Tara Leigh Weeks Vizcarra, M.D.
• Attea Voigt

• Clinical Social Worker in Sandpoint, ID
• Providers in Sandpoint, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.