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General NPI Number Information
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NPI Number | 1093905549
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Entity Type | Organization
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Legal Business Name | L BRIAN HERSCH & ASSOCIATES A PROFESSIONAL LLC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 4789 BRIAR RIDGE TRL
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City | BOULDER
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State | CO
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Zip | 80301-3902
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Country | US
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Telephone | 303-637-1739
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Fax | 303-530-7856
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Provider Business Mailing Address
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Address Line | 4789 BRIAR RIDGE TRL
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City | BOULDER
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State | CO
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Zip | 80301-3902
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Country | US
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Telephone | 303-637-1739
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Fax | 303-530-7856
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. LAWRENCE BRIAN HERSCH
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Credential | M.D.
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Telephone | 303-637-1739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 17277
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License Number State | CO
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