Provider Demographics
NPI:1376212985
Name:AGUIRRE HERRERA, AGUSTIN ALFONSO
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:ALFONSO
Last Name:AGUIRRE HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1906
Mailing Address - Country:US
Mailing Address - Phone:202-375-8381
Mailing Address - Fax:
Practice Address - Street 1:5503 43RD AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2078
Practice Address - Country:US
Practice Address - Phone:202-810-1624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC200002907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker