MEDICARE: DR. ANTHONY F. VERDI PH.D.

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	103TC0700X	Clinical Psychologist	PS005080-L	PA
2	103TC0700X	Clinical Psychologist	PS005080L	PA
3	103TC1900X	Counseling Psychologist	PS005080L	PA
4	103T00000X	Psychologist	PS005080L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	518813WLL	OTHER	PA	MEDICARE GROUP MEMBER PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	600412967	OTHER	PA	MAGELLAN BEHAVIORAL HEALTH

General Provider Information

NPI Number	:	1942489596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY F. VERDI PH.D.

Provider Business Mailing Address
First Line	:	420C FITZWATER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3109
Country	:	US
Telephone Number	:	215-592-0415
Fax Number	:	215-440-7774

Provider Business Practice Location Address
First Line	:	420C FITZWATER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3109
Country	:	US
Telephone Number	:	215-592-0415
Fax Number	:	215-440-7774

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	12/12/2018

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Directions to “ DR. ANTHONY F. VERDI PH.D.” Practice Location

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