Provider Demographics
NPI:1790151744
Name:KATZ, LAURA HERTZFELD
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:HERTZFELD
Last Name:KATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 N. HARRISON AVE.
Mailing Address - Street 2:PMB 124
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8707
Mailing Address - Country:US
Mailing Address - Phone:919-371-2850
Mailing Address - Fax:
Practice Address - Street 1:1143-B EXECUTIVE CIRCLE
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-8707
Practice Address - Country:US
Practice Address - Phone:919-371-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1327106H00000X
CA30712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist