Provider Demographics
NPI:1184918310
Name:VENUK, LAWRENCE (BCBA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:VENUK
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2669
Mailing Address - Country:US
Mailing Address - Phone:860-294-1543
Mailing Address - Fax:860-417-3805
Practice Address - Street 1:55 LISBON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2669
Practice Address - Country:US
Practice Address - Phone:860-294-1543
Practice Address - Fax:860-417-3805
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-03-1454103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst