Provider Demographics
NPI:1023245271
Name:O'HERRICK, WILLIAM MARTIN (BSED)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARTIN
Last Name:O'HERRICK
Suffix:
Gender:M
Credentials:BSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:PA
Mailing Address - Zip Code:15942-5909
Mailing Address - Country:US
Mailing Address - Phone:814-322-3303
Mailing Address - Fax:
Practice Address - Street 1:131 MARKET ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1628
Practice Address - Country:US
Practice Address - Phone:814-535-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15685182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health