Provider Demographics
NPI:1396259511
Name:HERWICK, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HERWICK
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 1:4225 BALTIMORE AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4493
Mailing Address - Country:US
Mailing Address - Phone:445-444-1642
Mailing Address - Fax:
Practice Address - Street 1:4225 BALTIMORE AVE APT 2R
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4493
Practice Address - Country:US
Practice Address - Phone:445-444-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional