Provider Demographics
NPI:1356694368
Name:GARNER, VENICE R (LCSW)
Entity type:Individual
Prefix:MS
First Name:VENICE
Middle Name:R
Last Name:GARNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MILL ST
Mailing Address - Street 2:#16115
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1041
Mailing Address - Country:US
Mailing Address - Phone:410-404-9461
Mailing Address - Fax:
Practice Address - Street 1:140 MILL ST
Practice Address - Street 2:#16115
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-1041
Practice Address - Country:US
Practice Address - Phone:410-404-9461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007672104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical