Provider Demographics
NPI:1558810523
Name:HERRING, ILSE ALEJANDRA (MSW)
Entity Type:Individual
Prefix:
First Name:ILSE
Middle Name:ALEJANDRA
Last Name:HERRING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14147 FRIAR ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2106
Mailing Address - Country:US
Mailing Address - Phone:818-425-2852
Mailing Address - Fax:
Practice Address - Street 1:14147 FRIAR ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2106
Practice Address - Country:US
Practice Address - Phone:818-425-2852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW73012104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker