Provider Demographics
NPI:1336116698
Name:HERRMANN, CHARLOTTE C (LICSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:C
Last Name:HERRMANN
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 1:585-597 MERRIMACK STREET
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854
Mailing Address - Country:US
Mailing Address - Phone:978-454-7685
Mailing Address - Fax:978-454-1681
Practice Address - Street 1:135 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:978-454-7685
Practice Address - Fax:978-454-1681
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04938Medicare ID - Type Unspecified