Provider Demographics
NPI:1649808148
Name:VENUTI, CAROL (MED, RBT)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:VENUTI
Suffix:
Gender:F
Credentials:MED, RBT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:VENUTI
Other - Last Name:MORGANSTERN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:9225 TOPANGA CANYON BLVD APT 37
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26702 OAK BRANCH CIR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-1454
Practice Address - Country:US
Practice Address - Phone:818-356-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS0264741OtherDRIVERS LICENSE