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NPI Code Detail

MEDICARE: KELLY HERRERA

MEDICARE: KELLY HERRERA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1548129828
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY HERRERA
Provider Business Mailing Address
First Line : 850 TOWBIN AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5928
Country : US
Telephone Number : 866-523-4268
Fax Number :
Provider Business Practice Location Address
First Line : 850 TOWBIN AVE
Second Line :
City : LAKEWOOD
State : NJ
Zip : 08701-5928
Country : US
Telephone Number : 866-523-4268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2026
Last Update Date : 01/21/2026

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Directions to “ KELLY HERRERA ” Practice Location

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