Provider Demographics
NPI:1013392182
Name:HERMAN, WILLIAM RANDOLPH (LCSW)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RANDOLPH
Last Name:HERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 ESTHER ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-2516
Mailing Address - Country:US
Mailing Address - Phone:386-402-4357
Mailing Address - Fax:
Practice Address - Street 1:108 ESTHER ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-2516
Practice Address - Country:US
Practice Address - Phone:386-402-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW24911041C0700X
MNLICSW 95771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical