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NPI Code Detail

MEDICARE: GWYNETH HERRERA MSW, ASW

MEDICARE: GWYNETH HERRERA MSW, ASW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker123410CA

General Provider Information

NPI Number : 1902471584
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWYNETH HERRERA MSW, ASW
Provider Business Mailing Address
First Line : 440 N BARRANCA AVE # 1535
Second Line :
City : COVINA
State : CA
Zip : 91723-1722
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 270 EAST LN
Second Line :
City : BURLINGAME
State : CA
Zip : 94010-2802
Country : US
Telephone Number : 877-505-7147
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2021
Last Update Date : 09/20/2024

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