Healthcare Provider Details

I. General information

NPI: 1124242706
Provider Name (Legal Business Name): JESSE J HERRERA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CAYUGA ST
SALINAS CA
93901-2626
US

IV. Provider business mailing address

1114 PALO ALTO WAY
SALINAS CA
93901-1083
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-3066
  • Fax: 831-751-6771
Mailing address:
  • Phone: 831-422-5354
  • Fax: 831-796-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 5803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: