Provider Demographics
NPI:1194347989
Name:VENEGAS, CARMEN PATRICIA (MA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:PATRICIA
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:PATRICIA
Other - Last Name:MEDINA-LEMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:3051 FAIRFIELD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-1132
Mailing Address - Country:US
Mailing Address - Phone:916-566-3490
Mailing Address - Fax:
Practice Address - Street 1:3051 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-1132
Practice Address - Country:US
Practice Address - Phone:916-600-7024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor