Provider Demographics
NPI:1629296157
Name:HERSCHLAG, JUDITH KNOX (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:KNOX
Last Name:HERSCHLAG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2015
Mailing Address - Country:US
Mailing Address - Phone:973-746-4899
Mailing Address - Fax:
Practice Address - Street 1:160 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2015
Practice Address - Country:US
Practice Address - Phone:973-746-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical