Provider Demographics
NPI:1073765434
Name:HERMAN, KATHARINE ANN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:ANN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:MRS
Other - First Name:KATHARINE
Other - Middle Name:ANN
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:125 WHIPPOORWILL WAY
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12821-1811
Mailing Address - Country:US
Mailing Address - Phone:518-642-2868
Mailing Address - Fax:
Practice Address - Street 1:125 WHIPPOORWILL WAY
Practice Address - Street 2:
Practice Address - City:COMSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12821
Practice Address - Country:US
Practice Address - Phone:518-642-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
07982225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist