Provider Demographics
NPI:1659508646
Name:VENNERI, REBECCA MARIE (MA, CAC DIPLOMATE)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:VENNERI
Suffix:
Gender:F
Credentials:MA, CAC DIPLOMATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANNON
Mailing Address - State:PA
Mailing Address - Zip Code:17020-8941
Mailing Address - Country:US
Mailing Address - Phone:717-350-9534
Mailing Address - Fax:
Practice Address - Street 1:1319 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-8941
Practice Address - Country:US
Practice Address - Phone:717-350-9534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA5353101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health