Provider Demographics
NPI:1245312818
Name:PATRICIA VERBY PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:PATRICIA VERBY PSYCHOLOGICAL SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERBY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:952-892-7690
Mailing Address - Street 1:1751 SOUTHCROSS DR W
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7012
Mailing Address - Country:US
Mailing Address - Phone:952-892-7690
Mailing Address - Fax:952-898-4930
Practice Address - Street 1:1751 SOUTHCROSS DR W
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-7012
Practice Address - Country:US
Practice Address - Phone:952-892-7690
Practice Address - Fax:952-898-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2905103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04494OtherMEDICARE IDENTIFICATION #