Provider Demographics
NPI:1720388408
Name:HERTENSTEIN, ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HERTENSTEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BRANDIWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2242
Mailing Address - Country:US
Mailing Address - Phone:407-416-5611
Mailing Address - Fax:
Practice Address - Street 1:3256 W LAKE MARY BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3588
Practice Address - Country:US
Practice Address - Phone:407-416-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2701106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist