=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356937668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD VENO EDD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2020
-----------------------------------------------------
Last Update Date | 12/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 GRISTMILL LN
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02364-1085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-585-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 GRISTMILL LN
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02364-1085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-585-7677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 2211
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------