Healthcare Provider Details

I. General information

NPI: 1114760972
Provider Name (Legal Business Name): LYANNE VENTURA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GLENMORE AVE
EWING NJ
08638-1209
US

IV. Provider business mailing address

5 GLENMORE AVE
EWING NJ
08638-1209
US

V. Phone/Fax

Practice location:
  • Phone: 609-619-9660
  • Fax:
Mailing address:
  • Phone: 609-619-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06004400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: