Provider Demographics
NPI:1225869845
Name:VENEGA, LYDIANA (MS, LMHC)
Entity type:Individual
Prefix:
First Name:LYDIANA
Middle Name:
Last Name:VENEGA
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:LYDIANA
Other - Middle Name:
Other - Last Name:VENEGA MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:1211 DANIA CIR NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-6352
Mailing Address - Country:US
Mailing Address - Phone:303-507-3482
Mailing Address - Fax:
Practice Address - Street 1:1938 DAIRY RD
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-4046
Practice Address - Country:US
Practice Address - Phone:321-574-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23605101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health