Provider Demographics
NPI:1982156386
Name:HERSH, JACQUELINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:HERSH
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 1:222 JOYCE LAWRENCE LN
Mailing Address - Street 2:ASU PSYCHOLOGY DEPARTMENT BOX 32109
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28608-2109
Mailing Address - Country:US
Mailing Address - Phone:828-262-6969
Mailing Address - Fax:828-262-2974
Practice Address - Street 1:522 WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7660
Practice Address - Country:US
Practice Address - Phone:828-262-6969
Practice Address - Fax:828-262-2974
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5088103TB0200X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent