MEDICARE: DR. STEVEN GRANT HERRICK 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	103TC0700X	Clinical Psychologist	PSY 10338	CA

General Provider Information

NPI Number	:	1942360748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN GRANT HERRICK PHD

Provider Business Mailing Address
First Line	:	577 E ELDER ST STE D
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-723-4911
Fax Number	:	760-723-4694

Provider Business Practice Location Address
First Line	:	577 E ELDER ST STE D
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-723-4911
Fax Number	:	760-723-4694

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/20/2010

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