Provider Demographics
NPI:1184161143
Name:HERMAN, RANDI (EDD)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:DR
Other - First Name:RANDI
Other - Middle Name:BETH
Other - Last Name:HERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:4020 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4331
Mailing Address - Country:US
Mailing Address - Phone:718-288-6348
Mailing Address - Fax:
Practice Address - Street 1:4020 AVENUE R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4331
Practice Address - Country:US
Practice Address - Phone:718-288-6348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency