Provider Demographics
NPI:1477899748
Name:HERR, TINA L (LSW)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:L
Last Name:HERR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FORT GRANVILLE LN
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-9308
Mailing Address - Country:US
Mailing Address - Phone:607-684-1711
Mailing Address - Fax:
Practice Address - Street 1:38 N 2ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074-1501
Practice Address - Country:US
Practice Address - Phone:717-567-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1320631041C0700X
NY089988-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical