Provider Demographics
NPI:1821292830
Name:VENASKA, LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:VENASKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 NE 17TH AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4985
Mailing Address - Country:US
Mailing Address - Phone:503-284-3847
Mailing Address - Fax:
Practice Address - Street 1:1820 SW VERMONT ST
Practice Address - Street 2:SUITE P
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-1945
Practice Address - Country:US
Practice Address - Phone:503-284-3847
Practice Address - Fax:801-340-1155
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130722Medicare PIN