Provider Demographics
NPI:1356595730
Name:HERRMANN, MICHAEL FOREST (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FOREST
Last Name:HERRMANN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4555
Mailing Address - Country:US
Mailing Address - Phone:317-254-1113
Mailing Address - Fax:
Practice Address - Street 1:11805 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4555
Practice Address - Country:US
Practice Address - Phone:317-254-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001060A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical