Provider Demographics
NPI:1538277934
Name:STEVEN MARK HERMAN
Entity type:Organization
Organization Name:STEVEN MARK HERMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSPP
Authorized Official - Phone:317-334-1481
Mailing Address - Street 1:1844 CENTURY WAY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5558
Mailing Address - Country:US
Mailing Address - Phone:317-334-1481
Mailing Address - Fax:317-581-9017
Practice Address - Street 1:1844 CENTURY WAY
Practice Address - Street 2:SUITE #1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5558
Practice Address - Country:US
Practice Address - Phone:317-334-1481
Practice Address - Fax:317-581-9017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040762A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100380620BMedicaid
IN275322000OtherMAGELLAN
IN275322000OtherMAGELLAN
IN264190Medicare ID - Type UnspecifiedMEDICARE