Provider Demographics
NPI:1487140125
Name:VENEY, BRENT EUGENE (ACSW)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:EUGENE
Last Name:VENEY
Suffix:
Gender:M
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2447 PACIFIC COAST HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2743
Mailing Address - Country:US
Mailing Address - Phone:240-273-3117
Mailing Address - Fax:240-292-7671
Practice Address - Street 1:2447 PACIFIC COAST HWY FL 2
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2743
Practice Address - Country:US
Practice Address - Phone:240-273-3117
Practice Address - Fax:240-292-7671
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-18-57167106S00000X
CA95105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician