MEDICARE: ZULEIDA A HERBA

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	101YM0800X	Mental Health Counselor	MH12730	FL
2	101YM0800X	Mental Health Counselor	171099	KY
3	101YM0800X	Mental Health Counselor	11034	MA

General Provider Information

NPI Number	:	1508488859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZULEIDA A HERBA

Provider Business Mailing Address
First Line	:	15 MAIN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4403
Country	:	US
Telephone Number	:	617-906-6958
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 CAMBRIDGEPARK DR
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02140-2485
Country	:	US
Telephone Number	:	617-906-6958
Fax Number	:

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

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	05/09/2020

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Directions to “ ZULEIDA A HERBA ” Practice Location

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