Provider Demographics
NPI:1801186747
Name:VENEZIO, SHARON (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:VENEZIO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 WILLIS AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-6014
Mailing Address - Country:US
Mailing Address - Phone:323-244-9015
Mailing Address - Fax:
Practice Address - Street 1:4616 WILLIS AVE APT 102
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-6014
Practice Address - Country:US
Practice Address - Phone:323-244-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst