Provider Demographics
NPI:1609042498
Name:VENDRAMIN, AUTUMN M (LMHC, BCBA)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:VENDRAMIN
Suffix:
Gender:F
Credentials:LMHC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4989 W 450 N
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7403
Mailing Address - Country:US
Mailing Address - Phone:219-508-1594
Mailing Address - Fax:219-359-3089
Practice Address - Street 1:442 N CALUMET RD
Practice Address - Street 2:STE 100
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2489
Practice Address - Country:US
Practice Address - Phone:219-359-3272
Practice Address - Fax:219-359-3089
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001748A101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst