Provider Demographics
NPI:1366065930
Name:VERINI, MICHAEL CHASE
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHASE
Last Name:VERINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 STANTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-1831
Mailing Address - Country:US
Mailing Address - Phone:212-995-2020
Mailing Address - Fax:
Practice Address - Street 1:219 STANTON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-1831
Practice Address - Country:US
Practice Address - Phone:212-995-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1236791182103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool