Provider Demographics
NPI:1942360748
Name:HERRICK, STEVEN GRANT (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GRANT
Last Name:HERRICK
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 1:577 E ELDER ST STE D
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-3079
Mailing Address - Country:US
Mailing Address - Phone:760-723-4911
Mailing Address - Fax:760-723-4694
Practice Address - Street 1:577 E ELDER ST STE D
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-723-4911
Practice Address - Fax:760-723-4694
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 10338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical