Provider Demographics
NPI:1942489596
Name:VERDI, ANTHONY F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:F
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 1:420C FITZWATER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3109
Mailing Address - Country:US
Mailing Address - Phone:215-592-0415
Mailing Address - Fax:215-440-7774
Practice Address - Street 1:420C FITZWATER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-3109
Practice Address - Country:US
Practice Address - Phone:215-592-0415
Practice Address - Fax:215-440-7774
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005080-L103TC0700X
PAPS005080L103TC0700X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA600412967OtherMAGELLAN BEHAVIORAL HEALTH
PA518813WLLOtherMEDICARE GROUP MEMBER PTAN