Provider Demographics
NPI:1033269881
Name:VENTURANZA, LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCILLE
Middle Name:
Last Name:VENTURANZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR1 BOX 137
Mailing Address - Street 2:
Mailing Address - City:TAWANDA
Mailing Address - State:PA
Mailing Address - Zip Code:18848-9730
Mailing Address - Country:US
Mailing Address - Phone:570-265-0100
Mailing Address - Fax:570-265-6741
Practice Address - Street 1:RR 1 BOX 137
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-9730
Practice Address - Country:US
Practice Address - Phone:570-265-0100
Practice Address - Fax:570-265-6741
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038085L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103300OtherPRIV INSURANCE
PA0005513480004Medicaid
PA0005513480004Medicaid