Provider Demographics
NPI:1336833912
Name:HERMAN, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55561 BLOOMINGDALE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43912-3208
Mailing Address - Country:US
Mailing Address - Phone:740-325-6194
Mailing Address - Fax:
Practice Address - Street 1:4697 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1303
Practice Address - Country:US
Practice Address - Phone:740-968-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
OHCDCA.183041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)