Provider Demographics
NPI:1457014656
Name:VANESSA VENTRICELLI COUNSELING LCSW LLC
Entity Type:Organization
Organization Name:VANESSA VENTRICELLI COUNSELING LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VENTRICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-719-3953
Mailing Address - Street 1:17 OLD HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-4168
Mailing Address - Country:US
Mailing Address - Phone:201-719-3953
Mailing Address - Fax:
Practice Address - Street 1:17 OLD HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-4168
Practice Address - Country:US
Practice Address - Phone:201-719-3953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)