Provider Demographics
NPI:1477396687
Name:HERRERA, STACEY RENEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 5763
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0058
Mailing Address - Country:US
Mailing Address - Phone:804-529-2197
Mailing Address - Fax:
Practice Address - Street 1:PSC 2 BOX 5763
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09012-0058
Practice Address - Country:US
Practice Address - Phone:804-529-2197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-15
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical