National Provider Identifier
Mitchell H Herzog, LCSW-R
Mitchell H Herzog, LCSW-R is listed in the NPPES registry with a primary specialty of Clinical Social Worker in Ithaca, NY and a listed phone number of (607) 277-7079.
Profile Overview
- NPI
- 1184801391
- Provider Type
- Individual
- Primary Specialty
- Clinical Social Worker
- Enumeration Date
- January 30, 2008
- Last Updated
- April 18, 2018
Practice Location
- 401 E State St
- Ste 201
- Ithaca, NY 14850-4400
Phone: (607) 277-7079
Specialties
- Clinical Social Worker (1041C0700X)
Full Record
- NPI
- 1184801391
- Entity Type
- Individual
- Last Name
- Herzog
- First Name
- Mitchell
- Middle Name
- H
- Name Prefix
- Mr.
- Credential
- LCSW-R
- Mailing Street Address
- 401 E State St
- Mailing Address Line 2
- Ste 201
- Mailing City
- Ithaca
- Mailing State
- NY
- Mailing ZIP Code
- 14850-4400
- Mailing Country
- US
- Mailing Phone
- (607) 277-7079
- Mailing Fax
- (607) 257-2919
- Practice Street Address
- 401 E State St
- Practice Address Line 2
- Ste 201
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-4400
- Practice Country
- US
- Practice Phone
- (607) 277-7079
- Practice Fax
- (607) 257-2919
- Enumeration Date
- January 30, 2008
- Last Updated
- April 18, 2018
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Clinical Social Worker (1041C0700X)