Provider Demographics
NPI:1922615525
Name:HERRERA, JACQUELINE BEATRIS (MSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:BEATRIS
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:B
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:227 PALISADE AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-3124
Mailing Address - Country:US
Mailing Address - Phone:347-370-0250
Mailing Address - Fax:
Practice Address - Street 1:529 COURTLANDT AVE FL 5
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5007
Practice Address - Country:US
Practice Address - Phone:347-370-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical