Provider Demographics
NPI:1902058340
Name:VERBY, HARRY D (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:D
Last Name:VERBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S AMPHLETT BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2509
Mailing Address - Country:US
Mailing Address - Phone:650-344-2704
Mailing Address - Fax:
Practice Address - Street 1:1660 S AMPHLETT BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2509
Practice Address - Country:US
Practice Address - Phone:650-344-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13395103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst