Provider Demographics
NPI:1760561286
Name:VENEGAS, LETTA BJORK (LCSW)
Entity Type:Individual
Prefix:
First Name:LETTA
Middle Name:BJORK
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 N BRAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3012
Mailing Address - Country:US
Mailing Address - Phone:213-219-7808
Mailing Address - Fax:
Practice Address - Street 1:1139 N BRAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3012
Practice Address - Country:US
Practice Address - Phone:213-219-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical