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General NPI Number Information
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NPI Number | 1396819686
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Entity Type | Individual
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Provider Name | NICHOLAS JOSEPH HERZMARK M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5845 COLLEGE AVE. SUITE 5
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City | OAKLAND
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State | CA
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Zip | 94618
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Country | US
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Telephone | 510-869-4341
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Fax | 415-454-0520
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Provider Business Mailing Address
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Address Line | 227 MARIN ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3713
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Country | US
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Telephone | 415-456-9553
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Fax | 415-454-0520
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC31852
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License Number State | CA
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