Basic Information
Provider Information
NPI: 1649728569
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERME
FirstName: ALYSON
MiddleName: CHRISTINE
NamePrefix: DR.
NameSuffix:  
Credential: PHD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3701 WILSHIRE BLVD STE 600
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900102814
CountryCode: US
TelephoneNumber: 3233613550
FaxNumber: 3233618052
Practice Location
Address1: 4650 W SUNSET BLVD
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 90027
CountryCode: US
TelephoneNumber: 3236602450
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/20/2016
LastUpdateDate: 11/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103T00000X2012728CAN Behavioral Health & Social Service ProvidersPsychologist 
208VP0000XPSY29571CAY Allopathic & Osteopathic PhysiciansPain MedicinePain Medicine

No ID Information.


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