Provider Demographics
NPI:1295775500
Name:HERZOG, CATHERINE L (PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:HERZOG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 N OAKLAND BLVD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4525
Mailing Address - Country:US
Mailing Address - Phone:248-886-1371
Mailing Address - Fax:248-886-1372
Practice Address - Street 1:1370 N OAKLAND
Practice Address - Street 2:SUITE 100A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4525
Practice Address - Country:US
Practice Address - Phone:248-886-1371
Practice Address - Fax:248-886-1372
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382603955Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST