Provider Demographics
NPI:1205455524
Name:DAVID, VENUS A (LBS)
Entity type:Individual
Prefix:
First Name:VENUS
Middle Name:A
Last Name:DAVID
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 BURMONT RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3032
Mailing Address - Country:US
Mailing Address - Phone:610-446-3680
Mailing Address - Fax:610-446-3682
Practice Address - Street 1:433 BURMONT RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3032
Practice Address - Country:US
Practice Address - Phone:610-446-3680
Practice Address - Fax:610-446-3682
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH004913103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty