Provider Demographics
NPI:1841594553
Name:MARANTZ-HERZBERG, JUDITH (MSW, CSWA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MARANTZ-HERZBERG
Suffix:
Gender:F
Credentials:MSW, CSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2046
Mailing Address - Country:US
Mailing Address - Phone:503-238-0048
Mailing Address - Fax:
Practice Address - Street 1:4605 NE FREMONT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1707
Practice Address - Country:US
Practice Address - Phone:503-789-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker