Provider Demographics
NPI:1770003287
Name:HERRERA, MADELINE
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
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 1:35 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-2353
Mailing Address - Country:US
Mailing Address - Phone:617-308-6223
Mailing Address - Fax:617-629-0010
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-2353
Practice Address - Country:US
Practice Address - Phone:617-308-6223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-26
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health