Healthcare Provider Details

I. General information

NPI: 1700490471
Provider Name (Legal Business Name): MARIA S HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8329 HARRISON AVE
MUNSTER IN
46321-2209
US

IV. Provider business mailing address

13401 S BUFFALO AVE
CHICAGO IL
60633-1835
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-0281
  • Fax:
Mailing address:
  • Phone: 773-447-8295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1998749
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: