Provider Demographics
NPI:1760775514
Name:ALDRIDGE-VENITUCCI, HEATHER R (LCSW-R)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:ALDRIDGE-VENITUCCI
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:VENITUCCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:2729 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2158
Mailing Address - Country:US
Mailing Address - Phone:917-412-3723
Mailing Address - Fax:718-504-9623
Practice Address - Street 1:2729 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2158
Practice Address - Country:US
Practice Address - Phone:917-412-3723
Practice Address - Fax:718-504-9623
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0823561041C0700X
NY0823561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03337217Medicaid