Healthcare Provider Details

I. General information

NPI: 1811621337
Provider Name (Legal Business Name): JOSLYN MARIE HERRERA CPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4985
  • Fax: 505-471-6084
Mailing address:
  • Phone: 505-471-4985
  • Fax: 505-471-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2024-0224
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1206
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: