Healthcare Provider Details

I. General information

NPI: 1740656149
Provider Name (Legal Business Name): COLETTE KENNY VERDES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 BIRKLAND PL # 1041
EASTON PA
18045-4701
US

IV. Provider business mailing address

4403 BIRKLAND PL # 1041
EASTON PA
18045-4701
US

V. Phone/Fax

Practice location:
  • Phone: 484-245-2010
  • Fax:
Mailing address:
  • Phone: 484-245-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013492
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC010000900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: