Provider Demographics
NPI:1356544126
Name:HERZOG, VICTORIA ELIZABETH (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ELIZABETH
Last Name:HERZOG
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:185 N REDWOOD DR STE 225
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1965
Mailing Address - Country:US
Mailing Address - Phone:415-322-0717
Mailing Address - Fax:888-974-6421
Practice Address - Street 1:185 N REDWOOD DR STE 225
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1965
Practice Address - Country:US
Practice Address - Phone:415-322-0717
Practice Address - Fax:888-974-6421
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist