Provider Demographics
NPI:1851059505
Name:HERRERA, JEFFREY MARTIN (BA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:MARTIN
Last Name:HERRERA
Suffix:
Gender:M
Credentials:BA
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:MARTIN
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BA
Mailing Address - Street 1:1148 CROES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4502
Mailing Address - Country:US
Mailing Address - Phone:929-358-9645
Mailing Address - Fax:
Practice Address - Street 1:1148 CROES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-4502
Practice Address - Country:US
Practice Address - Phone:929-358-9645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X, 101YM0800X, 104100000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker