Healthcare Provider Details

I. General information

NPI: 1164576799
Provider Name (Legal Business Name): JOHN DAVID VENNETTI MSED,LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MARKET ST
WARREN OH
44481-1141
US

IV. Provider business mailing address

908 LARKRIDGE AVE
BOARDMAN OH
44512-3135
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-6451
  • Fax: 330-394-6848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS0020647
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: