Provider Demographics
NPI:1962600510
Name:CHRISTINE HERMAN ACSW LCSW LLC
Entity type:Organization
Organization Name:CHRISTINE HERMAN ACSW LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:BARBARA
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW LCSW
Authorized Official - Phone:386-672-7274
Mailing Address - Street 1:570 MEMORIAL CIR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5002
Mailing Address - Country:US
Mailing Address - Phone:386-672-7274
Mailing Address - Fax:
Practice Address - Street 1:570 MEMORIAL CIR
Practice Address - Street 2:SUITE 310
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5002
Practice Address - Country:US
Practice Address - Phone:386-672-7274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW59321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6084Medicare ID - Type Unspecified