Provider Demographics
NPI:1932654290
Name:HERRERA, MARIA T (LSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:T
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 CAMDEN LN
Mailing Address - Street 2:UNIT D
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-3197
Mailing Address - Country:US
Mailing Address - Phone:217-414-4048
Mailing Address - Fax:
Practice Address - Street 1:4575 CAMDEN LN
Practice Address - Street 2:UNIT D
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-3197
Practice Address - Country:US
Practice Address - Phone:217-414-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0224551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150101628OtherLSW