Healthcare Provider Details

I. General information

NPI: 1235723933
Provider Name (Legal Business Name): NICOLE VENSKYTIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E BROAD ST STE 130-1017
BETHLEHEM PA
18018-5913
US

IV. Provider business mailing address

1744 FALCON DRIVE UNIT N
BETHLEHEM PA
18017
US

V. Phone/Fax

Practice location:
  • Phone: 484-403-0373
  • Fax:
Mailing address:
  • Phone: 717-201-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: NICOLE VENSKYTIS
Title or Position: OWNER
Credential: LPC
Phone: 484-403-0373