Provider Demographics
NPI:1902375280
Name:HERRERA, ADELAIDA (CASAC2)
Entity Type:Individual
Prefix:
First Name:ADELAIDA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:CASAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PELHAM PKWY N APT 516
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8072
Mailing Address - Country:US
Mailing Address - Phone:646-529-9381
Mailing Address - Fax:
Practice Address - Street 1:760 E 160TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-7815
Practice Address - Country:US
Practice Address - Phone:646-224-7071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)