Provider Demographics
NPI:1699933705
Name:NATHANIEL, VERNON IAN
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:IAN
Last Name:NATHANIEL
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 1:4117 LIBERTY AVE
Mailing Address - Street 2:DRAKE COUNSELING CENTER
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1446
Mailing Address - Country:US
Mailing Address - Phone:412-586-2950
Mailing Address - Fax:
Practice Address - Street 1:4117 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1446
Practice Address - Country:US
Practice Address - Phone:412-586-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4348072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry