Provider Demographics
NPI:1558098111
Name:VERDI, NICOLE J (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:J
Last Name:VERDI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 WETHEROLE ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4624
Mailing Address - Country:US
Mailing Address - Phone:917-723-7980
Mailing Address - Fax:
Practice Address - Street 1:8045 WINCHESTER BLVD BLDG 73
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2195
Practice Address - Country:US
Practice Address - Phone:718-264-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067245-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker