Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY4681 | FL |
N | 103TC0700X | Clinical Psychologist | PY4681 | FL |
N | 102L00000X | Psychologist | PY4681 | FL |
N | 103T00000X | Psychologist | PY4681 | FL |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PY4681 | FL |
N | 103TA0700X | Adult Development & Aging Psychologist | PY4681 | FL |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY4681 | FL |
N | 103G00000X | Clinical Psychologist | PY4681 | FL |
N | 103TC0700X | Clinical Psychologist | PY4681 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY4681 | FL |
N | 103TF0000X | Family Psychologist | PY4681 | FL |
N | 103TF0200X | Forensic Psychologist | PY4681 | FL |
N | 103TP2701X | Group Psychotherapist | PY4681 | FL |
NPI | 1346459625 |
---|---|
Provider Name | Dr. Michael John Herkov |
First Address | Jacksonville, FL 32256 |
Second Address | Jacksonville, FL 32256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |