Provider Demographics
NPI:1558404186
Name:HERRMANN, FAYE ELISE (LMFT)
Entity type:Individual
Prefix:MS
First Name:FAYE
Middle Name:ELISE
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:FAYE
Other - Middle Name:ELISE
Other - Last Name:NEUHAUSER-HERRMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:4164 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3400
Mailing Address - Country:US
Mailing Address - Phone:951-683-5193
Mailing Address - Fax:951-683-6019
Practice Address - Street 1:4164 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3400
Practice Address - Country:US
Practice Address - Phone:951-683-5193
Practice Address - Fax:951-683-6019
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist