Provider Demographics
NPI:1023179082
Name:HERBERT, PAUL PHILLIP (MS CAGS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:PHILLIP
Last Name:HERBERT
Suffix:
Gender:M
Credentials:MS CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 WALTHAM STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8033
Mailing Address - Country:US
Mailing Address - Phone:781-862-3600
Mailing Address - Fax:781-860-7636
Practice Address - Street 1:1040 WALTHAM STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-8033
Practice Address - Country:US
Practice Address - Phone:781-862-3600
Practice Address - Fax:781-860-7636
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP01332OtherBMC
MA1004745OtherNHP
MAM18633OtherBCBC
MA1303287OtherMBHP
MA1303287Medicaid
MA703136OtherTUFTS
MA1303287Medicaid