NPIMap

Eduardo Aguilar Velasquez, LCSW

Individual provider Active NPI Clinical Social Worker · Costa Mesa, CA

NPI 1720540412 · NPPES record last updated May 7, 2022

Key facts

NPI
1720540412
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
106496 (CA)
Practice address
301 Victoria St
Costa Mesa, CA 92627-7131
Phone
(949) 642-2734
NPI assigned
Apr 2, 2019
Sex
Male
Sole proprietor
No

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
106496CAMDMarriage & Family Therapist
83303CAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Western Youth Services Past Accepting new patients
New Alternatives Inc. Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 83303 CA
Clinical Social Worker 1041C0700X 106496 CA Yes

Addresses

Primary practice location

301 Victoria St
Costa Mesa, CA 92627-7131

Mailing address

301 Victoria St
Costa Mesa, CA 92627-7131
Phone (949) 642-2734

Other providers in Costa Mesa, CA

All providers in Costa Mesa, CA · Clinical Social Worker in California

Sources for this page

Verify at the official NPI Registry.