Healthcare Provider Details

I. General information

NPI: 1174073100
Provider Name (Legal Business Name): ALEXANDRA HERRERA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 RIDGE RUNNER RD
LAS VEGAS NM
87701-4971
US

IV. Provider business mailing address

PO BOX 335
LAS VEGAS NM
87701-0335
US

V. Phone/Fax

Practice location:
  • Phone: 505-429-0198
  • Fax:
Mailing address:
  • Phone: 505-429-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-09637
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: