Provider Demographics
NPI:1245531763
Name:HERBST, MATTHEW P (MS, CGC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:HERBST
Suffix:
Gender:M
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 SORENTO CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3107
Mailing Address - Country:US
Mailing Address - Phone:321-890-4160
Mailing Address - Fax:
Practice Address - Street 1:1793 SORENTO CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3107
Practice Address - Country:US
Practice Address - Phone:321-890-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS