Provider Demographics
NPI:1962682146
Name:CATZALCO, HERMILLE NMN (MA)
Entity Type:Individual
Prefix:
First Name:HERMILLE
Middle Name:NMN
Last Name:CATZALCO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GREENWICH LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1422
Mailing Address - Country:US
Mailing Address - Phone:209-571-1920
Mailing Address - Fax:209-571-1920
Practice Address - Street 1:107 GREENWICH LN
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1422
Practice Address - Country:US
Practice Address - Phone:209-571-1920
Practice Address - Fax:209-571-1920
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist