MEDICARE: JONATHAN JOSEPH VERHEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	071375	NY

General Provider Information

NPI Number	:	1841560166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN JOSEPH VERHEY LCSW

Provider Business Mailing Address
First Line	:	27 E RALEIGH AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-2811
Country	:	US
Telephone Number	:	917-968-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1346 VICTORY BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-3906
Country	:	US
Telephone Number	:	917-968-1445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	06/05/2014

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