Provider Demographics
NPI:1699182451
Name:HERSKOWITZ, ANNELISE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:HERSKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 SAINT PETER ST STE 429
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1119
Mailing Address - Country:US
Mailing Address - Phone:651-224-0614
Mailing Address - Fax:
Practice Address - Street 1:408 SAINT PETER ST STE 429
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1119
Practice Address - Country:US
Practice Address - Phone:651-224-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095023104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker