Provider Demographics
NPI:1134613474
Name:HERZ, JESSICA JANE (LMHC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:HERZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 MONTEGO BAY BLVD APT E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4033
Mailing Address - Country:US
Mailing Address - Phone:561-354-6915
Mailing Address - Fax:
Practice Address - Street 1:2623 S SEACREST BLVD STE 118
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7531
Practice Address - Country:US
Practice Address - Phone:561-354-6915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH16036OtherFLORIDA DEPARTMENT OF HEALTH