Provider Demographics
NPI:1497273650
Name:HERRMANN, BRIDGETTE ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:ROSE
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-5208
Mailing Address - Country:US
Mailing Address - Phone:650-817-9070
Mailing Address - Fax:650-817-9074
Practice Address - Street 1:1692 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-5208
Practice Address - Country:US
Practice Address - Phone:650-817-9070
Practice Address - Fax:650-817-9074
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113420106H00000X, 106H00000X
CA100379106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist