Provider Demographics
NPI:1821074915
Name:HERTZ, NOEL PAUL (MS, LMFT, LSW)
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:PAUL
Last Name:HERTZ
Suffix:
Gender:M
Credentials:MS, LMFT, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 N ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1202
Mailing Address - Country:US
Mailing Address - Phone:773-525-0753
Mailing Address - Fax:773-525-0636
Practice Address - Street 1:4350 N HERMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1106
Practice Address - Country:US
Practice Address - Phone:773-525-0753
Practice Address - Fax:773-525-0636
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150-2373104100000X
IL166-107106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist