Provider Demographics
NPI:1043438641
Name:VERDERICO, ROBERTA JAYNE (LMFT)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JAYNE
Last Name:VERDERICO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MAIN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4574
Mailing Address - Country:US
Mailing Address - Phone:408-472-8174
Mailing Address - Fax:408-776-3537
Practice Address - Street 1:50 W MAIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4574
Practice Address - Country:US
Practice Address - Phone:408-472-8174
Practice Address - Fax:408-776-3537
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist