Provider Demographics
NPI:1245331727
Name:HERR, BETTY (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:HERR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WARREN ST
Mailing Address - Street 2:BLDG 2, 3RD FLOOR
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3601
Mailing Address - Country:US
Mailing Address - Phone:617-787-4662
Mailing Address - Fax:617-787-4662
Practice Address - Street 1:77 WARREN ST
Practice Address - Street 2:BLDG 2, 3RD FLOOR
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3601
Practice Address - Country:US
Practice Address - Phone:617-787-4662
Practice Address - Fax:617-787-4662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA457812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA602105OtherTUFTS HEALTH PLAN
MAEO5217Medicare ID - Type Unspecified