Provider Demographics
NPI:1699185751
Name:DR. VERDEJO BEHAVIORAL HEALTH GROUP, P.S.C.
Entity Type:Organization
Organization Name:DR. VERDEJO BEHAVIORAL HEALTH GROUP, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERDEJO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-718-4755
Mailing Address - Street 1:PO BOX 192465
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2465
Mailing Address - Country:US
Mailing Address - Phone:787-718-4755
Mailing Address - Fax:
Practice Address - Street 1:3A ACUARELA STREET SUITE G4
Practice Address - Street 2:URB. MUNOZ RIVERA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-718-4755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3971103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty