Provider Demographics
NPI:1881800878
Name:VENZA, JAMES RAYMOND III (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RAYMOND
Last Name:VENZA
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MANCHESTER LN NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-2809
Mailing Address - Country:US
Mailing Address - Phone:202-297-1751
Mailing Address - Fax:
Practice Address - Street 1:4809 SAINT ELMO AVE
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3009
Practice Address - Country:US
Practice Address - Phone:202-297-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04041103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical