MEDICARE: DR. KENNETH L HERMAN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY10916	CA

General Provider Information

NPI Number	:	1215618038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L HERMAN PH.D.

Provider Business Mailing Address
First Line	:	1137 HUNTINGTON DR STE A2
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4580
Country	:	US
Telephone Number	:	323-344-0123
Fax Number	:	323-344-0123

Provider Business Practice Location Address
First Line	:	1137 HUNTINGTON DR STE A2
Second Line	:
City	:	SOUTH PASADENA
State	:	CA
Zip	:	91030-4580
Country	:	US
Telephone Number	:	323-344-0123
Fax Number	:	323-344-0123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	07/26/2023

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