Provider Demographics
NPI:1407857592
Name:VENEMA, JOSEPH RICHARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:VENEMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W. WASHINGTON ST
Mailing Address - Street 2:STE. 430
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-968-4078
Mailing Address - Fax:574-968-7252
Practice Address - Street 1:218 W WASHINGTON ST STE 430
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1899
Practice Address - Country:US
Practice Address - Phone:574-968-4078
Practice Address - Fax:574-968-7252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3770103TC0700X
IN20043011A103TF0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY3770OtherCALIFORNIA BOARD OF PSYCHOLOGY
CACP3770Medicare ID - Type UnspecifiedPROVIDER NUMBER