Provider Demographics
NPI:1518440361
Name:VERCELLINI, DONALD T JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:T
Last Name:VERCELLINI
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:T
Other - Last Name:VERCELLINI
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:676 ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-4532
Mailing Address - Country:US
Mailing Address - Phone:559-977-1307
Mailing Address - Fax:
Practice Address - Street 1:1322 E SHAW AVE STE 410
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7904
Practice Address - Country:US
Practice Address - Phone:559-226-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32692103TC0700X
CA94025665103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty