MEDICARE: CAROLINE MARIE HERRIG

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295395291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE MARIE HERRIG

Provider Business Mailing Address
First Line	:	16255 VENTURA BLVD STE 830
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-2317
Country	:	US
Telephone Number	:	563-513-9853
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 DOLLEY MADISON RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-4205
Country	:	US
Telephone Number	:	704-780-4271
Fax Number	:

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

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	09/18/2023

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