Provider Demographics
NPI:1255759643
Name:VENTRESCA, ANGELICA (LSW)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:VENTRESCA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6311
Mailing Address - Country:US
Mailing Address - Phone:610-861-8779
Mailing Address - Fax:610-861-4677
Practice Address - Street 1:308 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6311
Practice Address - Country:US
Practice Address - Phone:610-861-8779
Practice Address - Fax:610-861-4677
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW215851041C0700X
PASW131318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical