Provider Demographics
NPI:1629405667
Name:KRISTEN L. VERDELLI, MS, LPC: CANINE ASSISTED PSYCHOTHERAPY
Entity Type:Organization
Organization Name:KRISTEN L. VERDELLI, MS, LPC: CANINE ASSISTED PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:VERDELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:717-885-2712
Mailing Address - Street 1:160 S PROGRESS AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-4636
Mailing Address - Country:US
Mailing Address - Phone:717-885-2712
Mailing Address - Fax:717-885-2719
Practice Address - Street 1:160 S PROGRESS AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-4636
Practice Address - Country:US
Practice Address - Phone:717-885-2712
Practice Address - Fax:717-885-2719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007109101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty