Provider Demographics
NPI:1093884686
Name:VENEMA, SHARON R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
Last Name:VENEMA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2105
Mailing Address - Country:US
Mailing Address - Phone:574-213-4501
Mailing Address - Fax:
Practice Address - Street 1:1326 GARLAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2105
Practice Address - Country:US
Practice Address - Phone:574-213-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9963103G00000X, 103TC0700X
IN20043014A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist