Provider Demographics
NPI:1932283967
Name:VENKER, DIANE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:M
Last Name:VENKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:VENKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1034 S. BRENTWOOD BLVD.
Mailing Address - Street 2:SUITE 678
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117
Mailing Address - Country:US
Mailing Address - Phone:314-862-2305
Mailing Address - Fax:314-862-3425
Practice Address - Street 1:1034 S. BRENTWOOD BLVD
Practice Address - Street 2:SUITE 678
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-862-2305
Practice Address - Fax:314-862-3425
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004088101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor