Provider Demographics
NPI:1568966638
Name:HERTZ, KATHRYN VIVIAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:VIVIAN
Last Name:HERTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 LABOR IN VAIN RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2626
Mailing Address - Country:US
Mailing Address - Phone:617-821-8134
Mailing Address - Fax:
Practice Address - Street 1:2 N MAIN ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2215
Practice Address - Country:US
Practice Address - Phone:617-821-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical