Provider Demographics
NPI:1245407055
Name:HERL, DAVID (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HERL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36523
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44735-6523
Mailing Address - Country:US
Mailing Address - Phone:330-966-8086
Mailing Address - Fax:330-966-8086
Practice Address - Street 1:2677 CLEVELAND AVENUE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3393
Practice Address - Country:US
Practice Address - Phone:330-966-8086
Practice Address - Fax:330-966-8086
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2602103TC0700X
AZ212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R03034Medicare UPIN
HECP22771Medicare PIN