Provider Demographics
NPI:1215769781
Name:DIAZ HERRERA, ESTEPHANI (LAC)
Entity type:Individual
Prefix:
First Name:ESTEPHANI
Middle Name:
Last Name:DIAZ HERRERA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 ASHLAND AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-5490
Mailing Address - Country:US
Mailing Address - Phone:347-615-9521
Mailing Address - Fax:
Practice Address - Street 1:10 LANIDEX PLZ W STE 120
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-0221
Practice Address - Country:US
Practice Address - Phone:862-356-6059
Practice Address - Fax:973-363-9616
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00805500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health