Provider Demographics
NPI:1144359357
Name:ABBOTTVERDI, PH.D.S, PA
Entity type:Organization
Organization Name:ABBOTTVERDI, PH.D.S, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:972-869-2954
Mailing Address - Street 1:511 E JOHN CARPENTER FWY
Mailing Address - Street 2:#436
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3958
Mailing Address - Country:US
Mailing Address - Phone:972-869-2954
Mailing Address - Fax:972-869-4054
Practice Address - Street 1:511 E JOHN CARPENTER FWY
Practice Address - Street 2:#436
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3958
Practice Address - Country:US
Practice Address - Phone:972-869-2954
Practice Address - Fax:972-869-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24438103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty