Provider Demographics
NPI:1851697775
Name:VENISSE, HEATHER (MSW, ASW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:VENISSE
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GROVE ST # 323
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-359-9407
Mailing Address - Fax:
Practice Address - Street 1:101 GROVE ST # 323
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4505
Practice Address - Country:US
Practice Address - Phone:415-359-9407
Practice Address - Fax:415-359-9413
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical