Provider Demographics
NPI:1902354293
Name:HERRERA, KAORI
Entity Type:Individual
Prefix:
First Name:KAORI
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 1:735 CHESTNUT ST STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3759
Mailing Address - Country:US
Mailing Address - Phone:831-996-1222
Mailing Address - Fax:831-417-0443
Practice Address - Street 1:735 CHESTNUT ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060
Practice Address - Country:US
Practice Address - Phone:831-996-1222
Practice Address - Fax:831-417-0443
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT94960106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist