Provider Demographics
NPI:1356941595
Name:HERRERA, JOSSELINE A
Entity type:Individual
Prefix:
First Name:JOSSELINE
Middle Name:A
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-2575
Mailing Address - Country:US
Mailing Address - Phone:559-416-9395
Mailing Address - Fax:
Practice Address - Street 1:1915 HOWARD RD STE B&C
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5163
Practice Address - Country:US
Practice Address - Phone:559-330-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician