Provider Demographics
NPI:1497000756
Name:HERRMANN, JANET M
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 PERALTA BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5755
Mailing Address - Country:US
Mailing Address - Phone:510-713-3202
Mailing Address - Fax:510-713-0684
Practice Address - Street 1:4510 PERALTA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5755
Practice Address - Country:US
Practice Address - Phone:510-713-3202
Practice Address - Fax:510-713-0684
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010010AN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL0412282008OtherDRUG AND ALCOHOL REHABILITATION