Provider Demographics
NPI:1689171845
Name:HERRERA, JESSICA REBECCA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:REBECCA
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 1:10911 SW 245TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-4689
Mailing Address - Country:US
Mailing Address - Phone:301-717-7730
Mailing Address - Fax:
Practice Address - Street 1:10911 SW 245TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-4689
Practice Address - Country:US
Practice Address - Phone:301-717-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician