MEDICARE: HALINA HERMAN PHD

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	103T00000X	Psychologist	PY8896	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	184607	OTHER	KY	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1669425559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALINA HERMAN PHD

Provider Business Mailing Address
First Line	:	350 ALT 19
Second Line	:	C
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	722-254-9183
Fax Number	:	888-345-7010

Provider Business Practice Location Address
First Line	:	350 ALT 19
Second Line	:	C
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	727-254-9183
Fax Number	:	888-345-7010

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/16/2014

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Directions to “ HALINA HERMAN PHD” Practice Location

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