Organization
MARK A. HERRMANN, PH.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK A. HERRMANN PH.D. (PRESIDENT)
(812) 331-0946
Entity
Organization
Contact information
Practice address
3705 N BITTERSWEET DR, BLOOMINGTON, IN 47408-9656
(812) 331-0946
Mailing address
3705 N BITTERSWEET DR, BLOOMINGTON, IN 47408-9656
(812) 331-0946
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
57000132A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200043730B
—
IN
Enumeration date
12/11/2008
Last updated
12/11/2008
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