Provider Demographics
NPI:1538161211
Name:HERMAN, CHRISTINE BARBARA (ACSW, LCSW, LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BARBARA
Last Name:HERMAN
Suffix:
Gender:F
Credentials:ACSW, LCSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4118
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32175-4118
Mailing Address - Country:US
Mailing Address - Phone:386-672-7274
Mailing Address - Fax:
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-672-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2014-12-23
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
FLSW59321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9730OtherBLUE CROSS BLUE SHIELD
FLK6084Medicare ID - Type Unspecified