=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730399874
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN JAMES VERSER III LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 BUTTERFLY LN
-----------------------------------------------------
City | BLOOMSBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08804-3517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-479-1222
-----------------------------------------------------
Fax | 908-479-1172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 BUTTERFLY LN
-----------------------------------------------------
City | BLOOMSBURY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08804-3517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-479-1222
-----------------------------------------------------
Fax | 908-479-1172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 37FI00101300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------