Provider Demographics
NPI:1659856508
Name:HERZOG, CLAIRE (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:HERZOG
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5322 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2279
Mailing Address - Country:US
Mailing Address - Phone:402-457-5117
Mailing Address - Fax:
Practice Address - Street 1:5322 N 52ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2279
Practice Address - Country:US
Practice Address - Phone:402-457-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72621041S0200X
NE115641041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool