Provider Demographics
NPI:1316675291
Name:VENEGAS, MARY KATHERINE (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1190
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-1190
Mailing Address - Country:US
Mailing Address - Phone:561-972-1604
Mailing Address - Fax:
Practice Address - Street 1:308 TEQUESTA DR STE 1
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3049
Practice Address - Country:US
Practice Address - Phone:561-972-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health