Provider Demographics
NPI:1376965574
Name:HERZIG, CHARMAINE NOOSHIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:NOOSHIN
Last Name:HERZIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHARMAINE
Other - Middle Name:NOOSHIN
Other - Last Name:TAHERPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 NORTH VIGNES ST.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012
Mailing Address - Country:US
Mailing Address - Phone:805-640-6490
Mailing Address - Fax:
Practice Address - Street 1:124 N. VIGNES ST
Practice Address - Street 2:
Practice Address - City:L.A.
Practice Address - State:CA
Practice Address - Zip Code:90012
Practice Address - Country:US
Practice Address - Phone:805-640-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW207751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical