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General NPI Number Information
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NPI Number | 1770563066
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Entity Type | Organization
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Legal Business Name | VENTURA PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 409 E ELM ST
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City | LEBANON
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State | PA
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Zip | 17042-7629
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Country | US
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Telephone | 717-270-8844
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Fax | 717-270-1191
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Provider Business Mailing Address
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Address Line | 409 E ELM ST
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City | LEBANON
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State | PA
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Zip | 17042-7629
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Country | US
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Telephone | 717-270-8844
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Fax | 717-270-1191
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/PRESIDENT
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Name | GEORGETTE ROSE VENTURA
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Credential | M.S.
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Telephone | 717-270-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS006312L
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License Number State | PA
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