Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ASW62270 | CA |
Y | 1041C0700X | Clinical Social Worker | LCSW79804 | CA |
NPI | 1003296039 |
---|---|
Provider Name | Christina Herzog-Kabisch |
First Address | Pasadena, CA 91105-2711 |
Second Address | Pasadena, CA 91105-2711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 08/11/2017 |