Provider Demographics
NPI:1922202233
Name:HERZHAFT, STEPHANIE THERESA (LMSW)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:THERESA
Last Name:HERZHAFT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:THERESA
Other - Last Name:LEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:713 N CENTER DR NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544
Mailing Address - Country:US
Mailing Address - Phone:616-648-6909
Mailing Address - Fax:
Practice Address - Street 1:11652 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9203
Practice Address - Country:US
Practice Address - Phone:616-897-5900
Practice Address - Fax:616-897-5954
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010923541041C0700X
MI6802085960104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker