Provider Demographics
NPI:1487017554
Name:VENNING, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:VENNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST
Mailing Address - Street 2:ROOM 1213 - UNIVERSITY OF MIAMI/EARLY STEPS PROGRAM
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-6600
Mailing Address - Fax:305-243-3501
Practice Address - Street 1:1120 NW 14TH ST
Practice Address - Street 2:ROOM 1213 - UNIVERSITY OF MIAMI/EARLY STEPS PROGRAM
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-243-6600
Practice Address - Fax:305-243-3501
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPPLIED FOR #Medicaid