Physician Compare National (NPI:1336128834)

HEALTHCARE PROVIDER: CYNTHIA N HERZOG LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336128834
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911268701
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180219000812
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HERZOG
	Individual professional last name
Provider First Name	CYNTHIA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	101 TIMBERLACHEN CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	LAKE MARY
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	327466124
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y