Provider Demographics
NPI:1336128834
Name:HERZOG, CYNTHIA N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:N
Last Name:HERZOG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 TIMBERLACHEN CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6124
Mailing Address - Country:US
Mailing Address - Phone:407-324-9440
Mailing Address - Fax:407-330-5244
Practice Address - Street 1:101 TIMBERLACHEN CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6124
Practice Address - Country:US
Practice Address - Phone:407-324-9440
Practice Address - Fax:407-330-5244
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW0020241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4208OtherBCBS
FL1366501512OtherNPI CORP
FLZ4208Medicare ID - Type UnspecifiedMEDICARE