Doctor Name: | JONATHAN D HERZOG |
NPI Number: | 1023306677 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | LH60389198 |
Business Practice Address: | 2275 Arlington Dr San Leandro, CA - 945781132 |
Business Phone Number: | 5103171444 |
Business Fax Number: | |
Mailing Address: | 2275 Arlington Dr, SAN LEANDRO |
State: | CA |
Postal Code: | 945781132 |
Phone Number: | 5103171444 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2011 |
NPI Last Update Date: | 03/24/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LH60389198 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |