Provider Demographics
NPI:1639389976
Name:HERTZ, MARJORIE CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:CAROL
Last Name:HERTZ
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 1:123 HAVILAND LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3023
Mailing Address - Country:US
Mailing Address - Phone:914-997-0359
Mailing Address - Fax:914-997-7878
Practice Address - Street 1:85 5TH AVE
Practice Address - Street 2:SUITE 909
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:212-243-8546
Practice Address - Fax:914-997-7878
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028232-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical