Provider Demographics
NPI:1861550568
Name:HERZBERG, JOAN E (LCPC)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:E
Last Name:HERZBERG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:JOAN
Other - Middle Name:H
Other - Last Name:SCHALLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:2580 HYBERNIA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5506
Mailing Address - Country:US
Mailing Address - Phone:847-433-5871
Mailing Address - Fax:
Practice Address - Street 1:405 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3006
Practice Address - Country:US
Practice Address - Phone:847-441-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor