Provider Demographics
NPI:1760551204
Name:HERR, LAURIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:HERR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LELAND ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4030
Mailing Address - Country:US
Mailing Address - Phone:707-477-7658
Mailing Address - Fax:
Practice Address - Street 1:132 LELAND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4030
Practice Address - Country:US
Practice Address - Phone:707-477-7658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical