Provider Demographics
NPI:1205658820
Name:HERSCHBERGER, MARY E (LICSW-A)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HERSCHBERGER
Suffix:
Gender:F
Credentials:LICSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E WESTVIEW CT STE B
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1376
Mailing Address - Country:US
Mailing Address - Phone:509-626-9430
Mailing Address - Fax:509-626-9436
Practice Address - Street 1:1111 E WESTVIEW CT STE B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1376
Practice Address - Country:US
Practice Address - Phone:509-626-9430
Practice Address - Fax:509-626-9436
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA616043091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical