Provider Demographics
NPI:1104092584
Name:HERRERA, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 W HILLSBORO BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4397
Mailing Address - Country:US
Mailing Address - Phone:305-305-6367
Mailing Address - Fax:561-423-3105
Practice Address - Street 1:5300 W HILLSBORO BLVD STE 208
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4397
Practice Address - Country:US
Practice Address - Phone:305-305-6367
Practice Address - Fax:561-423-3105
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 10390101YM0800X
222Q00000X
FL11415726103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist