Provider Demographics
NPI:1699920306
Name:VENGER, YVONNE SUSANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:SUSANNE
Last Name:VENGER
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:P.O.B. 1992
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038
Mailing Address - Country:US
Mailing Address - Phone:858-404-0838
Mailing Address - Fax:619-260-8455
Practice Address - Street 1:4550 KEARNY VILLA ROAD
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:619-516-4757
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical