Provider Demographics
NPI:1124242706
Name:HERRERA, JESSE J (LCSW)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:J
Last Name:HERRERA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 PALO ALTO WAY
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-1083
Mailing Address - Country:US
Mailing Address - Phone:831-422-5354
Mailing Address - Fax:831-796-8568
Practice Address - Street 1:115 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2626
Practice Address - Country:US
Practice Address - Phone:831-796-3066
Practice Address - Fax:831-751-6771
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 58031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS5803OtherLIC CLINICAL SOCIAL WKR