Provider Demographics
NPI:1467279729
Name:HERMAN, KEN RAYMOND JR (PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:KEN
Middle Name:RAYMOND
Last Name:HERMAN
Suffix:JR
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 BURNSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-4812
Mailing Address - Country:US
Mailing Address - Phone:443-252-1788
Mailing Address - Fax:
Practice Address - Street 1:800 TYDINGS LN
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2102
Practice Address - Country:US
Practice Address - Phone:800-799-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206179363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health