Provider Demographics
NPI:1578645974
Name:VENTURA, GEORGETTE (MS)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:VENTURA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-6322
Mailing Address - Country:US
Mailing Address - Phone:717-270-8844
Mailing Address - Fax:717-202-2612
Practice Address - Street 1:511 NOBLE ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-6322
Practice Address - Country:US
Practice Address - Phone:717-270-8844
Practice Address - Fax:717-202-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-OO6312-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06541Medicare UPIN
PAR06541Medicare UPIN