Provider Demographics
NPI:1184227282
Name:VENTER, ADAM SERGIO (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:SERGIO
Last Name:VENTER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:SERGIO
Other - Middle Name:
Other - Last Name:VALSAHAGUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:156 PORTER ST APT 434
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2162
Mailing Address - Country:US
Mailing Address - Phone:602-566-4887
Mailing Address - Fax:
Practice Address - Street 1:1340 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4302
Practice Address - Country:US
Practice Address - Phone:617-267-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2260521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical