Provider Demographics
NPI:1164509717
Name:HERR, JUDITH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:HERR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 GREAT ROAD
Mailing Address - Street 2:BOUNDARIES THERAPY CENTER
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-263-4878
Mailing Address - Fax:798-635-0386
Practice Address - Street 1:518 GREAT ROAD
Practice Address - Street 2:BOUNDARIES THERAPY CENTER
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-263-4878
Practice Address - Fax:798-635-0386
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1074341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P06615Medicare UPIN