Provider Demographics
NPI:1215463419
Name:VERDURA, LIDIA VITTORIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:VITTORIA
Last Name:VERDURA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BUNKER HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1803
Mailing Address - Country:US
Mailing Address - Phone:203-232-9705
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-1803
Practice Address - Country:US
Practice Address - Phone:203-232-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT370104100000X
CT97981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker