Provider Demographics
NPI:1154690188
Name:HERBST, CARRIE
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:HERBST
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:TAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1390 DENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:415-378-6946
Mailing Address - Fax:
Practice Address - Street 1:1390 DENTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118
Practice Address - Country:US
Practice Address - Phone:415-378-6946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53480106H00000X
CALMFT53480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist