Joseph Richard Venema, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20043011A Issued in IN

Practice address

218 W Washington St Ste 430
South Bend, IN 46601-1899

Phone

(574) 968-4078

Fax

(574) 968-7252

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Joseph R. Venema PH.D. a Psychological Corp

  • Clinical Neuropsychologist
  • Pasadena, CA
  • NPI 1932223435
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407857592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 W. WASHINGTON ST",
            "address_2": "STE. 430",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "46601",
            "telephone_number": "574-968-4078",
            "fax_number": "574-968-7252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 W WASHINGTON ST STE 430",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011899",
            "telephone_number": "574-968-4078",
            "fax_number": "574-968-7252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1326 Garland Rd",
            "address_purpose": "LOCATION",
            "city": "South Bend",
            "state": "IN",
            "postal_code": "466142105",
            "country_code": "US",
            "telephone_number": "574-344-0978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VENEMA",
        "first_name": "JOSEPH",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY3770",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "IN",
            "license": "20043011A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20043011A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF PSYCHOLOGY",
            "identifier": "PSY3770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol L. Vaughn, WHNP RNC
• Vav Operations LLC (Lighthouse Autism Center)
• Daniel Vega-Lescano
• Ashley Veglucci, PT
• Shawna Vegso
• Sharon R Venema, PSY.D.
• Ernest Alexander Vera-Vazquez, D.O
• Jessica Czajkowski Vera
• Shelby Lyn Verhage, PT
• Morgan Verhamme, RBT

• Clinical Psychologist in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.