Provider Demographics
NPI:1346732625
Name:VENUTI, SYDNEY JOHNA (LICSW)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:JOHNA
Last Name:VENUTI
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 1:1045 ELM ST STE 401
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1824
Mailing Address - Country:US
Mailing Address - Phone:978-225-3442
Mailing Address - Fax:
Practice Address - Street 1:1045 ELM ST STE 401
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1824
Practice Address - Country:US
Practice Address - Phone:978-225-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
101YA0400X, 104100000X
NH29061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)