Provider Demographics
NPI:1154547743
Name:PICKHOLTZ, HERSCHEL JUDAH (EDD)
Entity type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:JUDAH
Last Name:PICKHOLTZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24100 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5535
Mailing Address - Country:US
Mailing Address - Phone:216-831-8098
Mailing Address - Fax:216-360-0518
Practice Address - Street 1:24100 CHAGRIN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5535
Practice Address - Country:US
Practice Address - Phone:216-831-8098
Practice Address - Fax:216-360-0518
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2826103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling