Provider Demographics
NPI:1457548299
Name:HERZOG, KATHERINE EMILIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:EMILIE
Last Name:HERZOG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MAIN ST STE 2
Mailing Address - Street 2:COLONY CARE
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-695-7447
Mailing Address - Fax:508-695-0345
Practice Address - Street 1:841 MAIN ST STE 2
Practice Address - Street 2:COLONY CARE
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-695-7447
Practice Address - Fax:508-695-0345
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist