Provider Demographics
NPI:1235775313
Name:HERZBERG, SHARI ANN (RBT)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WALTONS PASS
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8250
Mailing Address - Country:US
Mailing Address - Phone:706-951-0176
Mailing Address - Fax:
Practice Address - Street 1:1135 WALTONS PASS
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8250
Practice Address - Country:US
Practice Address - Phone:904-505-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician