MEDICARE: DR. SUSAN J. HERMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	SI00940	NJ

General Provider Information

NPI Number	:	1689743635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN J. HERMAN PH.D.

Provider Business Mailing Address
First Line	:	37 GLEN ROCK RD
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-2447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 GLEN ROCK RD
Second Line	:
City	:	LITTLE FALLS
State	:	NJ
Zip	:	07424-2447
Country	:	US
Telephone Number	:	973-890-0719
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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