Provider Demographics
NPI:1619628997
Name:HERMANN, JAIME ROSE
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:ROSE
Last Name:HERMANN
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 1:9 WOODSIDE TER
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5688
Mailing Address - Country:US
Mailing Address - Phone:845-554-4492
Mailing Address - Fax:
Practice Address - Street 1:20 CENTURY HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2198
Practice Address - Country:US
Practice Address - Phone:518-785-7283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health