Doctor Name: | JAMES A HERMANSON |
NPI Number: | 1104174440 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | 7199 |
Business Practice Address: | 5833 Pecan St P.o. 723 North Branch, MN - 550567093 |
Business Phone Number: | 6512774283 |
Business Fax Number: | 6512774284 |
Mailing Address: | 5833 Pecan St, P.o. 723 NORTH BRANCH |
State: | MN |
Postal Code: | 550567093 |
Phone Number: | 6512774283 |
Fax Number: | 6512774284 |
NPI Enumeration Date: | 08/16/2012 |
NPI Last Update Date: | 08/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 7199 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |