| Laurie E Herzog Phd Pc | |
|
155 Main St Northampton MA 01060-3259 | |
| (413) 586-7774 | |
| Not Available |
| Full Name | Laurie E Herzog Phd Pc |
|---|---|
| Speciality | Social Worker |
| Location | 155 Main St, Northampton, Massachusetts |
| Authorized Official Name and Position | Laurie E. Herzog (PRESIDENT) |
| Authorized Official Contact | 4135867774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laurie E Herzog Phd Pc 155 Main St Northampton MA 01060-3259 Ph: (413) 586-7774 | Laurie E Herzog Phd Pc 155 Main St Northampton MA 01060-3259 Ph: (413) 586-7774 |
| NPI Number | 1407277007 |
|---|---|
| Provider Enumeration Date | 12/27/2013 |
| Last Update Date | 08/25/2014 |
| Medicare PECOS PAC ID | 0749409415 |
|---|---|
| Medicare Enrollment ID | O20140910002279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407277007 | NPI | - | NPPES |
| P04562 | Other | MA | MEDICARE PTAN |
| 1548317274 | Other | MA | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1015410 (Massachusetts) | Primary |
| Provider Name | Laurie E Herzog |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548317274 PECOS PAC ID: 6800812223 Enrollment ID: I20051014000691 |
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