Provider Demographics
NPI:1811377245
Name:HERRINGTON, JOHN IV
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HERRINGTON
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3325
Mailing Address - Country:US
Mailing Address - Phone:215-590-7555
Mailing Address - Fax:215-590-7387
Practice Address - Street 1:3440 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3325
Practice Address - Country:US
Practice Address - Phone:215-590-7555
Practice Address - Fax:215-590-7387
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017799103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist