Provider Demographics
NPI:1952758757
Name:HERRERA, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
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 1:6725 SW 152ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2214
Mailing Address - Country:US
Mailing Address - Phone:786-760-7265
Mailing Address - Fax:
Practice Address - Street 1:8300 NW 53RD ST
Practice Address - Street 2:SUITE 350
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-7712
Practice Address - Country:US
Practice Address - Phone:305-776-0728
Practice Address - Fax:561-828-3124
Is Sole Proprietor?:No
Enumeration Date:2016-05-21
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBCBA11832648103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst