Provider Demographics
NPI:1265193098
Name:SAMANTHA HERTZ, LICENSED CLINICAL SOCIAL WORKER
Entity type:Organization
Organization Name:SAMANTHA HERTZ, LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ELYSE
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-472-7767
Mailing Address - Street 1:22815 VENTURA BLVD # 405
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1202
Mailing Address - Country:US
Mailing Address - Phone:818-538-9372
Mailing Address - Fax:
Practice Address - Street 1:22815 VENTURA BLVD # 405
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1202
Practice Address - Country:US
Practice Address - Phone:818-538-9372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty