Provider Demographics
NPI:1922879253
Name:HERMAN, DORY
Entity Type:Individual
Prefix:
First Name:DORY
Middle Name:
Last Name:HERMAN
Suffix:
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 1:845 RUSSELL AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2101
Mailing Address - Country:US
Mailing Address - Phone:707-217-6935
Mailing Address - Fax:
Practice Address - Street 1:339 S E ST STE 4
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5132
Practice Address - Country:US
Practice Address - Phone:707-385-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist