Provider Demographics
NPI:1982344024
Name:HEATHER ALDRIDGE-VENITUCCI, LCSW, PLLC
Entity Type:Organization
Organization Name:HEATHER ALDRIDGE-VENITUCCI, LCSW, PLLC
Other - Org Name:HEATHER VENITUCCI, LCSW-R
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDRIDGE-VENITUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:917-412-3723
Mailing Address - Street 1:2729 ALBANY POST RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2158
Mailing Address - Country:US
Mailing Address - Phone:091-741-2372
Mailing Address - Fax:718-504-9623
Practice Address - Street 1:2729 ALBANY POST RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:NY
Practice Address - Zip Code:12549-2158
Practice Address - Country:US
Practice Address - Phone:091-741-2372
Practice Address - Fax:718-504-9623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-29
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07731437Medicaid
NY03337217Medicaid