Healthcare Provider Details

I. General information

NPI: 1215618038
Provider Name (Legal Business Name): KENNETH L HERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 HUNTINGTON DR STE A2
SOUTH PASADENA CA
91030-4580
US

IV. Provider business mailing address

1137 HUNTINGTON DR STE A2
SOUTH PASADENA CA
91030-4580
US

V. Phone/Fax

Practice location:
  • Phone: 323-344-0123
  • Fax: 323-344-0123
Mailing address:
  • Phone: 323-344-0123
  • Fax: 323-344-0123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10916
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: