Provider Demographics
NPI:1144451972
Name:HEINZELMANN, VERONICA BINGHAM
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:BINGHAM
Last Name:HEINZELMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1073 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3034
Mailing Address - Country:US
Mailing Address - Phone:805-302-7209
Mailing Address - Fax:
Practice Address - Street 1:300 N SAN ANTONIO RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1316
Practice Address - Country:US
Practice Address - Phone:805-681-5209
Practice Address - Fax:805-681-4084
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25761101YA0400X, 101YP2500X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker