Provider Demographics
NPI:1457530297
Name:VERDUGO, HENRY L (LCSW)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:L
Last Name:VERDUGO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PINE ST
Mailing Address - Street 2:SUITE B2
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1640
Mailing Address - Country:US
Mailing Address - Phone:208-627-8988
Mailing Address - Fax:208-263-5581
Practice Address - Street 1:515 PINE ST STE B2
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1640
Practice Address - Country:US
Practice Address - Phone:208-627-8988
Practice Address - Fax:208-263-5581
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID28573101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health