Provider Demographics
NPI:1811494453
Name:HERMAN, LAURA ANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANNE
Last Name:HERMAN
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 1:120 SAINT ALBANS DR APT 416
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5805
Mailing Address - Country:US
Mailing Address - Phone:502-548-9415
Mailing Address - Fax:
Practice Address - Street 1:4455 MORRIS PARK DR STE A
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-9264
Practice Address - Country:US
Practice Address - Phone:502-548-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5310103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC824609362Medicaid