Provider Demographics
NPI:1225291958
Name:VENILIA GARDENS, INC
Entity Type:Organization
Organization Name:VENILIA GARDENS, INC
Other - Org Name:CULTURAL COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-996-8800
Mailing Address - Street 1:142 FIELD VIEW LN
Mailing Address - Street 2:PO BOX 870
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-7607
Mailing Address - Country:US
Mailing Address - Phone:508-996-8800
Mailing Address - Fax:508-996-8688
Practice Address - Street 1:142 FIELD VIEW LN
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-7607
Practice Address - Country:US
Practice Address - Phone:508-996-8800
Practice Address - Fax:508-996-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259101YM0800X
NY0016381101YM0800X
MA160106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0137530Medicaid
MA0000000024854Medicaid
MA018365033OtherUNITED BEHAVIORAL HEALTH
MA1892711Medicaid
MALMG030OtherBCBCMA