Provider Demographics
NPI:1326250093
Name:HERZOG, MARGARET LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:LOUISE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WEST BROOKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-1747
Mailing Address - Country:US
Mailing Address - Phone:914-834-4944
Mailing Address - Fax:
Practice Address - Street 1:69 W BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-1747
Practice Address - Country:US
Practice Address - Phone:914-834-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7489103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist