Provider Demographics
NPI:1801236211
Name:HERTZ, KIMBERLY (LCSW-R)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HERTZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 23RD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4582
Mailing Address - Country:US
Mailing Address - Phone:212-951-0947
Mailing Address - Fax:
Practice Address - Street 1:125 E 23RD ST STE 400
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4582
Practice Address - Country:US
Practice Address - Phone:212-951-0947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0846081041C0700X
NY089737-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker