Provider Demographics
NPI:1417054214
Name:HERTZLER, ELEANOR LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:LOUISE
Last Name:HERTZLER
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 1:1475 HUNTINGTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5990
Mailing Address - Country:US
Mailing Address - Phone:650-873-5825
Mailing Address - Fax:
Practice Address - Street 1:1475 HUNTINGTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5990
Practice Address - Country:US
Practice Address - Phone:650-873-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS139641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical