MEDICARE: JENNIFER ROSE HERRERA LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	53489	TX

General Provider Information

NPI Number	:	1235444720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROSE HERRERA LMSW

Provider Business Mailing Address
First Line	:	PO BOX 40362
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-1362
Country	:	US
Telephone Number	:	210-535-9427
Fax Number	:	210-657-3876

Provider Business Practice Location Address
First Line	:	5570 KISSING OAK ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1510
Country	:	US
Telephone Number	:	210-535-9427
Fax Number	:	210-657-3876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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