Provider Demographics
NPI:1952658536
Name:HERZON, RANDY ALAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:ALAN
Last Name:HERZON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:SCHNECKSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18078-3543
Mailing Address - Country:US
Mailing Address - Phone:610-730-0443
Mailing Address - Fax:610-481-0052
Practice Address - Street 1:1650 BROADWAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3904
Practice Address - Country:US
Practice Address - Phone:610-799-8600
Practice Address - Fax:610-799-8154
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional