Provider Demographics
NPI:1679788913
Name:HERMAN, BRUCE J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:HERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BRUCE
Other - Middle Name:GRANT
Other - Last Name:JASCHIK-HERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 DUNKIRK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1816
Mailing Address - Country:US
Mailing Address - Phone:410-499-6043
Mailing Address - Fax:
Practice Address - Street 1:312 W CHESAPEAKE AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4405
Practice Address - Country:US
Practice Address - Phone:410-499-6043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03408103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist