Provider Demographics
NPI:1194855122
Name:VENEZIA, AMY L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2309
Mailing Address - Country:US
Mailing Address - Phone:617-921-6423
Mailing Address - Fax:
Practice Address - Street 1:69 ALLEGHANY ST
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-3336
Practice Address - Country:US
Practice Address - Phone:617-524-4620
Practice Address - Fax:617-983-1658
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1109521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical