Provider Demographics
NPI:1558386318
Name:HERR, CHARLES FERNANDEZ (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FERNANDEZ
Last Name:HERR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3 STUYVESANT OVAL
Mailing Address - Street 2:APT. 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2145
Mailing Address - Country:US
Mailing Address - Phone:917-714-2348
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:80 EIGHTH AVENUE
Practice Address - Street 2:SUITE 1305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:917-714-2348
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV3A991Medicare ID - Type UnspecifiedNYS MEDICARE#
NYS64443Medicare UPIN