MEDICARE: MR. LARRY LYNN HERL

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	PS007420L	PA

General Provider Information

NPI Number	:	1578516332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY LYNN HERL

Provider Business Mailing Address
First Line	:	8615 MEADVILLE RD
Second Line	:
City	:	GIRARD
State	:	PA
Zip	:	16417-9225
Country	:	US
Telephone Number	:	814-774-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 E STATE ST
Second Line	:	BOX 116
City	:	ALBION
State	:	PA
Zip	:	16401-1348
Country	:	US
Telephone Number	:	814-756-4600
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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