Provider Demographics
NPI:1902854847
Name:HERSCH, LEE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:E
Last Name:HERSCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 N AUGUSTA ST
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3202
Mailing Address - Country:US
Mailing Address - Phone:540-886-5060
Mailing Address - Fax:540-886-7380
Practice Address - Street 1:1228 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3202
Practice Address - Country:US
Practice Address - Phone:540-886-5060
Practice Address - Fax:540-886-7380
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006212OtherANTHEM
VA007714149Medicaid
VA620000193Medicare ID - Type UnspecifiedMEDICARE