Provider Demographics
NPI:1083268031
Name:VENEZIA, CATHY ANN (MSED)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANN
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N ALMADEN AVE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-2776
Mailing Address - Country:US
Mailing Address - Phone:917-612-0673
Mailing Address - Fax:
Practice Address - Street 1:77 N ALMADEN AVE
Practice Address - Street 2:SUITE #102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-2776
Practice Address - Country:US
Practice Address - Phone:917-612-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11937289103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst