Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00624200 | NJ |
NPI | 1003384454 |
---|---|
Provider Name | Kimberly Ann Herman |
First Address | Howell, NJ 07731-2359 |
Second Address | Brick, NJ 08724-2320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2018 |
Last Update Date | 04/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0029807 | (05) | NJ |