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General NPI Number Information
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NPI Number | 1669600383
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Entity Type | Individual
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Provider Name | ELLYN D HERB PSYCHOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 1101 S WINCHESTER BLVD SUITE M-258
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City | SAN JOSE
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State | CA
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Zip | 95128-3901
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Country | US
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Telephone | 408-296-9600
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Fax | 408-225-1773
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Provider Business Mailing Address
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Address Line | 1101 S WINCHESTER BLVD SUITE M-258
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City | SAN JOSE
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State | CA
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Zip | 95128-3901
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Country | US
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Telephone | 408-296-9600
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Fax | 408-225-1773
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10462
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License Number State | CA
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