Provider Demographics
NPI:1154539245
Name:HERZBERG, LORRIE R (MSW)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:R
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLONIAL VILLAGE DR
Mailing Address - Street 2:2
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3925
Mailing Address - Country:US
Mailing Address - Phone:857-939-8265
Mailing Address - Fax:
Practice Address - Street 1:1 COLONIAL VILLAGE DR
Practice Address - Street 2:2
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3925
Practice Address - Country:US
Practice Address - Phone:857-939-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10290911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11696009OtherCAQH
MAHE 22324Medicare ID - Type UnspecifiedMEDICARE