Provider Demographics
NPI:1417657917
Name:HERRERA, KEVIN (MSW, PEL)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MSW, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 BECKHAM LN
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5032
Mailing Address - Country:US
Mailing Address - Phone:630-220-2192
Mailing Address - Fax:
Practice Address - Street 1:1752 CAPITAL ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124
Practice Address - Country:US
Practice Address - Phone:847-695-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health