Provider Demographics
NPI:1235723933
Name:NICOLE VENSKYTIS, LLC
Entity Type:Organization
Organization Name:NICOLE VENSKYTIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VENSKYTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-403-0373
Mailing Address - Street 1:1744 FALCON DRIVE
Mailing Address - Street 2:UNIT N
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017
Mailing Address - Country:US
Mailing Address - Phone:717-201-4427
Mailing Address - Fax:
Practice Address - Street 1:1 E BROAD ST STE 130
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5934
Practice Address - Country:US
Practice Address - Phone:484-403-0373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty