Basic Information
| Provider Information | |||||||||
| NPI: | 1699920306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VENGER | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | SUSANNE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O.B. 1992 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584040838 | ||||||||
| FaxNumber: | 6192608455 | ||||||||
| Practice Location | |||||||||
| Address1: | 4550 KEARNY VILLA ROAD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582791223 | ||||||||
| FaxNumber: | 6195164757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2008 | ||||||||
| LastUpdateDate: | 11/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 24797 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.