MEDICARE: HEATHER R ALDRIDGE-VENITUCCI LCSW-R

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R082356	NY
2	1041C0700X	Clinical Social Worker	082356	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760775514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER R ALDRIDGE-VENITUCCI LCSW-R

Provider Business Mailing Address
First Line	:	2729 ALBANY POST RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2158
Country	:	US
Telephone Number	:	917-412-3723
Fax Number	:	718-504-9623

Provider Business Practice Location Address
First Line	:	2729 ALBANY POST RD
Second Line	:
City	:	MONTGOMERY
State	:	NY
Zip	:	12549-2158
Country	:	US
Telephone Number	:	917-412-3723
Fax Number	:	718-504-9623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	06/16/2023

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