Healthcare Provider Details

I. General information

NPI: 1104399435
Provider Name (Legal Business Name): VENITA AUGUSTE-DUVERSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 E UPSAL ST
PHILADELPHIA PA
19119-2031
US

IV. Provider business mailing address

PO BOX 32
PHILADELPHIA PA
19105-0032
US

V. Phone/Fax

Practice location:
  • Phone: 347-314-2955
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: