Provider Demographics
NPI:1336427921
Name:HERDEN, MARCIA JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:JANE
Last Name:HERDEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 EMPIRE BLVD
Mailing Address - Street 2:STE. 2B
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1935
Mailing Address - Country:US
Mailing Address - Phone:585-671-3180
Mailing Address - Fax:
Practice Address - Street 1:2112 EMPIRE BLVD
Practice Address - Street 2:STE. 2B
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1935
Practice Address - Country:US
Practice Address - Phone:585-671-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-30
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012382-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical