Provider Demographics
NPI:1902190374
Name:VENEZIA, RACHAEL ANGELA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:ANGELA
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 H EL CAMINO REAL #395
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-1303
Mailing Address - Country:US
Mailing Address - Phone:650-762-8687
Mailing Address - Fax:
Practice Address - Street 1:1212 H EL CAMINO REAL #395
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-1303
Practice Address - Country:US
Practice Address - Phone:650-762-8687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64972106H00000X
CALMFT89898106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist