Provider Demographics
NPI:1568719474
Name:HERRERA, IMARA SCARLETT (ASW)
Entity Type:Individual
Prefix:MISS
First Name:IMARA
Middle Name:SCARLETT
Last Name:HERRERA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MISS
Other - First Name:IMARA
Other - Middle Name:SCARLETT
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASW
Mailing Address - Street 1:10159 FELIPE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14600 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3363
Practice Address - Country:US
Practice Address - Phone:626-337-6611
Practice Address - Fax:626-856-5653
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 33601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health