Provider Demographics
NPI:1770662686
Name:VERDI, JOHN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:VERDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E JOHN CARPENTER FWY
Mailing Address - Street 2:#436
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3958
Mailing Address - Country:US
Mailing Address - Phone:962-869-2965
Mailing Address - Fax:972-869-4054
Practice Address - Street 1:511 E JOHN CARPENTER FWY
Practice Address - Street 2:#436
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3958
Practice Address - Country:US
Practice Address - Phone:962-869-2965
Practice Address - Fax:972-869-4054
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24456103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
00H94RMedicare ID - Type Unspecified