Healthcare Provider Details

I. General information

NPI: 1063360329
Provider Name (Legal Business Name): EMILY VENESSA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 LOMAS BLVD NW
ALBUQUERQUE NM
87102-1955
US

IV. Provider business mailing address

6716 LA ROCCA RD NW
ALBUQUERQUE NM
87114-3451
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-7492
  • Fax:
Mailing address:
  • Phone: 505-400-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: