Provider Demographics
NPI:1104174440
Name:HERMANSON, JAMES A (LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:HERMANSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5833 PECAN ST
Mailing Address - Street 2:P.O. 723
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-7093
Mailing Address - Country:US
Mailing Address - Phone:651-277-4283
Mailing Address - Fax:651-277-4284
Practice Address - Street 1:5833 PECAN ST
Practice Address - Street 2:P.O. 723
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-7093
Practice Address - Country:US
Practice Address - Phone:651-277-4283
Practice Address - Fax:651-277-4284
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN71991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical