Healthcare Provider Details

I. General information

NPI: 1649608852
Provider Name (Legal Business Name): KAREN A VENEZIA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2013
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JTCC @HUMC 92 SECOND STREET JTCC 3RD FLOOR
HACKENSACK NJ
07601
US

IV. Provider business mailing address

HUMC 30 PROSPECT AVE. JTCC 3RD FLOOR
HACKENSACK NJ
07601
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-5836
  • Fax: 551-996-0816
Mailing address:
  • Phone: 551-996-5836
  • Fax: 551-996-0816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00168900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: