Healthcare Provider Details

I. General information

NPI: 1144555962
Provider Name (Legal Business Name): RICHARD D. HERMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2009
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 S. US HWY. 1
TITUSVILLE FL
32780-9152
US

IV. Provider business mailing address

400 SHERIDAN RD
MELBOURNE FL
32901-3122
US

V. Phone/Fax

Practice location:
  • Phone: 321-890-1500
  • Fax:
Mailing address:
  • Phone: 321-722-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: