Provider Demographics
NPI:1669950846
Name:HERMAN, ELLIE (LCSW)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:HERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S MARKET ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SELINSGROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17870-1845
Mailing Address - Country:US
Mailing Address - Phone:272-231-5452
Mailing Address - Fax:
Practice Address - Street 1:3 S MARKET ST STE 4
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-1845
Practice Address - Country:US
Practice Address - Phone:272-231-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1041C0700X
PACW0215781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical