Provider Demographics
NPI:1487930558
Name:VENABLE, CECILIA ELLEN (BA)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:ELLEN
Last Name:VENABLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:331 BEACH 31 STREET
Mailing Address - Street 2:APT 8G
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691
Mailing Address - Country:US
Mailing Address - Phone:718-327-7660
Mailing Address - Fax:718-327-4230
Practice Address - Street 1:135 W 50TH ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1201
Practice Address - Country:US
Practice Address - Phone:718-327-7660
Practice Address - Fax:718-327-4230
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 171M00000X
NY320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness