Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 36147 | TX |
N | 103TF0000X | Family Psychologist | 36147 | TX |
NPI | 1023203023 |
---|---|
Provider Name | Dr. Brooke Hersh |
First Address | Austin, TX 78717 |
Second Address | Round Rock, TX 78681-5796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 04/06/2013 |