Healthcare Provider Details

I. General information

NPI: 1942911235
Provider Name (Legal Business Name): JOSEPHINE VENEZIA LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MAPLE ST
MASSAPEQUA NY
11758-2636
US

IV. Provider business mailing address

95 N MAPLE ST
N MASSAPEQUA NY
11758-2636
US

V. Phone/Fax

Practice location:
  • Phone: 516-841-4113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE VENEZIA
Title or Position: PROVIDER
Credential:
Phone: 516-841-4113