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General NPI Number Information
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NPI Number | 1104187590
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Entity Type | Individual
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Provider Name | WILLIAM JOSEPH HERAN PH.D., LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/02/2012
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Last Update Date | 06/02/2012
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Provider Practice Location Address
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Address Line | 355 LANCASTER AVE BLDG. E, 2ND FLOOR
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City | HAVERFORD
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State | PA
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Zip | 19041-1547
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Country | US
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Telephone | 215-834-7979
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SUMMIT DR
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City | BRYN MAWR
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State | PA
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Zip | 19010-2217
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Country | US
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Telephone | 215-834-7979
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW016842
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License Number State | PA
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