Healthcare Provider Details

I. General information

NPI: 1265139471
Provider Name (Legal Business Name): CELINA DIANA HERRERA MSW, MPH, LMSW, CHES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SPRUCE ST SE
ALBUQUERQUE NM
87106-5226
US

IV. Provider business mailing address

509 SPRUCE ST SE
ALBUQUERQUE NM
87106-5226
US

V. Phone/Fax

Practice location:
  • Phone: 505-373-7820
  • Fax:
Mailing address:
  • Phone: 505-373-7820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0974
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: