Provider Demographics
NPI:1841697430
Name:HERBERT, JUDITH (MS)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 CHD RD.
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656
Mailing Address - Country:US
Mailing Address - Phone:740-418-4545
Mailing Address - Fax:
Practice Address - Street 1:1987 CH&D RD.
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656
Practice Address - Country:US
Practice Address - Phone:740-418-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP270103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool