Provider Demographics
NPI:1639617269
Name:HERRERA, VIRGINIA ARCENIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ARCENIA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 LEWMAY RD
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2083
Mailing Address - Country:US
Mailing Address - Phone:646-399-7797
Mailing Address - Fax:
Practice Address - Street 1:3008 LEWMAY RD
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2083
Practice Address - Country:US
Practice Address - Phone:646-399-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator