Provider Demographics
NPI:1114321106
Name:HERTZ, ELIZABETH M (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:HERTZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:HERTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:4659 REINHARDT DR.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:510-644-4228
Mailing Address - Fax:
Practice Address - Street 1:1415 OAKLAND BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:510-644-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 81232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist