Healthcare Provider Details

I. General information

NPI: 1861747156
Provider Name (Legal Business Name): CARLA GUEVARA-HERRERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 VIA VERDE STE 200
SAN DIMAS CA
91773-3993
US

IV. Provider business mailing address

180 VIA VERDE STE 200
SAN DIMAS CA
91773-3993
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-1227
  • Fax:
Mailing address:
  • Phone: 909-599-1227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number100389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW78902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: