Provider Demographics
NPI:1669425559
Name:HERMAN, HALINA (PHD)
Entity type:Individual
Prefix:
First Name:HALINA
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ALT 19
Mailing Address - Street 2:C
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5303
Mailing Address - Country:US
Mailing Address - Phone:722-254-9183
Mailing Address - Fax:888-345-7010
Practice Address - Street 1:350 ALT 19
Practice Address - Street 2:C
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5303
Practice Address - Country:US
Practice Address - Phone:727-254-9183
Practice Address - Fax:888-345-7010
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8896103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER
KY610661458OtherFEDERAL TAX ID NUMBER