Provider Demographics
NPI:1376632711
Name:HERMAN, PATRICIA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241
Mailing Address - Country:US
Mailing Address - Phone:513-769-5111
Mailing Address - Fax:513-769-1333
Practice Address - Street 1:4100 EXECUTIVE PARK DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241
Practice Address - Country:US
Practice Address - Phone:513-769-5111
Practice Address - Fax:513-769-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5770103TC1900X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2288902Medicaid
KY89001085Medicaid
OHHECP28811Medicare PIN
P82622Medicare UPIN
OH2288902Medicaid