Provider Demographics
NPI:1861015265
Name:HERRERA, JENNY G (RBT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:G
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2088 ARDEN FOREST PL
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-2306
Mailing Address - Country:US
Mailing Address - Phone:301-922-0839
Mailing Address - Fax:
Practice Address - Street 1:1700 WELLS RD # 1516
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2337
Practice Address - Country:US
Practice Address - Phone:904-637-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119063106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician