Healthcare Provider Details

I. General information

NPI: 1376632711
Provider Name (Legal Business Name): PATRICIA LYNN HERMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 EXECUTIVE PARK DRIVE SUITE 2
CINCINNATI OH
45241
US

IV. Provider business mailing address

4100 EXECUTIVE PARK DRIVE SUITE 2
CINCINNATI OH
45241
US

V. Phone/Fax

Practice location:
  • Phone: 513-769-5111
  • Fax: 513-769-1333
Mailing address:
  • Phone: 513-769-5111
  • Fax: 513-769-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5770
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: