Provider Demographics
NPI:1568989929
Name:HERZBERG, ELEANOR MARGARET
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MARGARET
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 CHICAGO AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2392
Mailing Address - Country:US
Mailing Address - Phone:847-946-6483
Mailing Address - Fax:
Practice Address - Street 1:811 CHICAGO AVE
Practice Address - Street 2:APT 401
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202
Practice Address - Country:US
Practice Address - Phone:847-946-6483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health