Provider Demographics
NPI:1548276496
Name:HERMAN, STEVEN MARK (PHD HSPP)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:HERMAN
Suffix:
Gender:M
Credentials:PHD HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 CEDAR PLACE DR
Mailing Address - Street 2:SUITE #111-A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2344
Mailing Address - Country:US
Mailing Address - Phone:317-334-1481
Mailing Address - Fax:317-581-9017
Practice Address - Street 1:8555 CEDAR PLACE DRIVE
Practice Address - Street 2:SUITE #111-A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2344
Practice Address - Country:US
Practice Address - Phone:317-334-1481
Practice Address - Fax:317-581-9017
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040762A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN275322000OtherANTHEM
IN100380620BMedicaid
INR94174Medicare UPIN
IN264190Medicare PIN