Provider Demographics
NPI:1851703425
Name:HERRO, MARY JESSICA I (MED)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JESSICA
Last Name:HERRO
Suffix:I
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:JESSICA
Other - Last Name:HERRO
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:17100 N 67TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3698
Mailing Address - Country:US
Mailing Address - Phone:602-938-3323
Mailing Address - Fax:602-938-1626
Practice Address - Street 1:17100 N 67TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3698
Practice Address - Country:US
Practice Address - Phone:602-938-3323
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional