1265054720 NPI number — DEBRA HERSCHBERG HOLDER LCSW

Table of content: DEBRA HERSCHBERG HOLDER LCSW (NPI 1265054720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265054720 NPI number — DEBRA HERSCHBERG HOLDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDER
Provider First Name:
DEBRA
Provider Middle Name:
HERSCHBERG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265054720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7002 ROCKSPRING LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92346-5461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-496-4173
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4259 W SWAMP RD STE 404
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOYLESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18902-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-892-3800
Provider Business Practice Location Address Fax Number:
484-468-1412
Provider Enumeration Date:
05/07/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW021786 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: LCSW73544 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)