Provider Demographics
NPI:1447287685
Name:HERMAN, JOHN ANDREWS (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREWS
Last Name:HERMAN
Suffix:
Gender:M
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:PO BOX 1328
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-1328
Mailing Address - Country:US
Mailing Address - Phone:970-259-2162
Mailing Address - Fax:970-247-0455
Practice Address - Street 1:475 LEWIS STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-264-2104
Practice Address - Fax:970-247-0455
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ65698Medicare UPIN
CO804894Medicare ID - Type Unspecified