Provider Demographics
NPI:1457619280
Name:HERZBERG, GENESEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GENESEE
Middle Name:
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 ASHBY AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1835
Mailing Address - Country:US
Mailing Address - Phone:510-863-1104
Mailing Address - Fax:
Practice Address - Street 1:2185 ASHBY AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1835
Practice Address - Country:US
Practice Address - Phone:510-863-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 26407OtherCALIFORNIA BOARD OF PSYCHOLOGY