Provider Demographics
NPI:1720441017
Name:VENTIMIGLIA, RAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:RAYNE
Middle Name:
Last Name:VENTIMIGLIA
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 1:1611 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3436
Mailing Address - Country:US
Mailing Address - Phone:817-874-8169
Mailing Address - Fax:
Practice Address - Street 1:1901 CENTRAL DR STE 812
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5858
Practice Address - Country:US
Practice Address - Phone:817-874-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical