Provider Demographics
NPI:1831383918
Name:VERDINI, DOMENIC JASON (MSED, LPC)
Entity type:Individual
Prefix:MR
First Name:DOMENIC
Middle Name:JASON
Last Name:VERDINI
Suffix:
Gender:M
Credentials:MSED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MURRAY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1657
Mailing Address - Country:US
Mailing Address - Phone:412-759-5918
Mailing Address - Fax:
Practice Address - Street 1:1900 MURRAY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1657
Practice Address - Country:US
Practice Address - Phone:412-759-5918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2008-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019786630001Medicaid