Provider Demographics
NPI:1093946089
Name:HERZENACH, NANCY MARIA
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIA
Last Name:HERZENACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 MADER RD. #N BOX 119
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3063
Mailing Address - Country:US
Mailing Address - Phone:805-319-7951
Mailing Address - Fax:
Practice Address - Street 1:1687 ERRINGER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6508
Practice Address - Country:US
Practice Address - Phone:805-319-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist