Healthcare Provider Details

I. General information

NPI: 1487140125
Provider Name (Legal Business Name): BRENT EUGENE VENEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 MELODY LN STE 114
ROSEVILLE CA
95678-5100
US

IV. Provider business mailing address

116 S GRANT ST STE 110
ROSEVILLE CA
95678-2668
US

V. Phone/Fax

Practice location:
  • Phone: 279-206-8094
  • Fax:
Mailing address:
  • Phone: 279-206-8094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-57167
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: