Provider Demographics
NPI:1386888980
Name:VENEGAS, ROSA MARIA (LCSW)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:VENEGAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 N MARKS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0288
Mailing Address - Country:US
Mailing Address - Phone:559-248-8580
Mailing Address - Fax:
Practice Address - Street 1:7080 N MARKS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0288
Practice Address - Country:US
Practice Address - Phone:559-248-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 220641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical