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General NPI Number Information
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NPI Number | 1407277007
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Entity Type | Organization
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Legal Business Name | LAURIE E HERZOG PHD PC
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Dates
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Enumeration Date | 12/27/2013
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 155 MAIN ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3259
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Country | US
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Telephone | 413-586-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 155 MAIN ST
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3259
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Country | US
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Telephone | 413-586-7774
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAURIE E. HERZOG
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Credential | PH.D.
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Telephone | 413-586-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1015410
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License Number State | MA
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