Provider Demographics
NPI:1992354773
Name:HERRERA, ERICK RONALDO (PHD)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:RONALDO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 4627
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9230
Mailing Address - Country:US
Mailing Address - Phone:787-457-7562
Mailing Address - Fax:
Practice Address - Street 1:ROAD 456 KM 0.4 BO. PUERTOS
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9230
Practice Address - Country:US
Practice Address - Phone:787-820-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical