Provider Demographics
NPI:1922487776
Name:HERTZBERG, ARIELLE MARIN (MA)
Entity Type:Individual
Prefix:
First Name:ARIELLE
Middle Name:MARIN
Last Name:HERTZBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ARIELLE
Other - Middle Name:MARIN
Other - Last Name:BAKHSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:290 IOOF AVE.
Mailing Address - Street 2:REBEKAH CHILDRENS SERVICES
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:290 IOOF AVE.
Practice Address - Street 2:REBEKAH CHILDRENS SERVICES
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-846-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist