Provider Demographics
NPI:1386787794
Name:HERMAN, LORI (MAC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WASHINGTON ST
Mailing Address - Street 2:LL7
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4455
Mailing Address - Country:US
Mailing Address - Phone:781-461-0390
Mailing Address - Fax:
Practice Address - Street 1:450 WASHINGTON ST
Practice Address - Street 2:LL7
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4455
Practice Address - Country:US
Practice Address - Phone:781-461-0390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist