Healthcare Provider Details

I. General information

NPI: 1144428442
Provider Name (Legal Business Name): JOSEPH R VERDINO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 E 17TH ST
BROOKLYN NY
11229-2101
US

IV. Provider business mailing address

7344 AUSTIN ST APT 5X
FOREST HILLS NY
11375-6225
US

V. Phone/Fax

Practice location:
  • Phone: 347-624-0705
  • Fax:
Mailing address:
  • Phone: 718-360-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number018919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: