Provider Demographics
NPI:1932219151
Name:HERSKOVITZ, MINDY S (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:S
Last Name:HERSKOVITZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 ANTHONY TRL
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2536
Mailing Address - Country:US
Mailing Address - Phone:847-205-0186
Mailing Address - Fax:
Practice Address - Street 1:444 ANTHONY TRL
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2536
Practice Address - Country:US
Practice Address - Phone:847-205-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional