Healthcare Provider Details

I. General information

NPI: 1891535514
Provider Name (Legal Business Name): MICHAEL VERILE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKLINE PL STE 105
BROOKLINE MA
02445-7294
US

IV. Provider business mailing address

1 BROOKLINE PL STE 105
BROOKLINE MA
02445-7294
US

V. Phone/Fax

Practice location:
  • Phone: 617-278-8000
  • Fax:
Mailing address:
  • Phone: 617-278-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number026649
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10001063
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: