Provider Demographics
NPI:1801034673
Name:VERDUIN, TIMOTHY LEONARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEONARD
Last Name:VERDUIN
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 1:577 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6404
Mailing Address - Country:US
Mailing Address - Phone:212-263-8914
Mailing Address - Fax:
Practice Address - Street 1:577 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6404
Practice Address - Country:US
Practice Address - Phone:212-263-8914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2009-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist