Provider Demographics
NPI:1285105874
Name:HERRON, KATHLEEN MONICA
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MONICA
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 JUNIPER CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-1618
Mailing Address - Country:US
Mailing Address - Phone:631-495-7912
Mailing Address - Fax:
Practice Address - Street 1:246 JUNIPER CT
Practice Address - Street 2:
Practice Address - City:MIDDLE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11953-1618
Practice Address - Country:US
Practice Address - Phone:631-495-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist