Active NPI
Lee M. Herzog, M.B.A., PSY.D.
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1306087176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 18054
- Practice address
- 11911 San Vicente Blvd
Suite 270
Los Angeles, CA 90049-5086 - Phone
- (310) 712-2501
- NPI assigned
- Mar 9, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | PSY 18054 | CA | |
| Clinical Psychologist | 103TC0700X | PSY 18054 | CA | Primary |
Addresses
Primary practice location
11911 San Vicente Blvd
Suite 270
Los Angeles, CA 90049-5086
Mailing address
11911 San Vicente Blvd
Suite 270
Los Angeles, CA 90049-5086
Phone (310) 712-2501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 18054 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1236556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236556800000",
"number": "1306087176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11911 SAN VICENTE BLVD",
"address_2": "SUITE 270",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495086",
"telephone_number": "310-712-2501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11911 SAN VICENTE BLVD",
"address_2": "SUITE 270",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495086",
"telephone_number": "310-712-2501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZOG",
"first_name": "LEE",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "M.B.A., PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-03-09",
"last_updated": "2009-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "CA",
"license": "PSY 18054",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 18054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.