Provider Demographics
NPI:1609923465
Name:HERDMAN, MARY A (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:HERDMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PINCKNEY RD APT A
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2123
Mailing Address - Country:US
Mailing Address - Phone:732-747-8280
Mailing Address - Fax:732-842-0372
Practice Address - Street 1:24 PINCKNEY RD APT A
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2123
Practice Address - Country:US
Practice Address - Phone:732-747-8280
Practice Address - Fax:732-842-0372
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC0019340001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4216798OtherAETNA
NJ7496330OtherGHI
NJ640404Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER