MEDICARE: HERMAN PSYCHOLOGY

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	3075	CT

General Provider Information

NPI Number	:	1912269531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERMAN PSYCHOLOGY

Provider Business Mailing Address
First Line	:	21 HAZEL TER
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2209
Country	:	US
Telephone Number	:	203-848-7590
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 HAZEL TER
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2209
Country	:	US
Telephone Number	:	203-848-7590
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. ARYEH ISAAC HERMAN
Credential	:	PSY.D.
Telephone Number	:	203-848-7590

Provider Enumeration Date	:	06/10/2012
Last Update Date	:	06/23/2015

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