Provider Demographics
NPI:1356937668
Name:VENO, RICHARD (EDD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:VENO
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 GRISTMILL LN
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1085
Mailing Address - Country:US
Mailing Address - Phone:781-585-7677
Mailing Address - Fax:
Practice Address - Street 1:13 GRISTMILL LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1085
Practice Address - Country:US
Practice Address - Phone:781-585-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2211103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist