Provider Demographics
NPI:1952331175
Name:HERTL, HENRY G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:G
Last Name:HERTL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TODD DR E
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1424
Mailing Address - Country:US
Mailing Address - Phone:516-676-3273
Mailing Address - Fax:
Practice Address - Street 1:1517 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4804
Practice Address - Country:US
Practice Address - Phone:516-746-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN28241Medicare ID - Type UnspecifiedLCSW