Provider Demographics
NPI:1548954282
Name:HERRERA RAMIREZ, JUAN ANTONIO (MSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ANTONIO
Last Name:HERRERA RAMIREZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 JORDAN STUART CIR APT 106
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-2408
Mailing Address - Country:US
Mailing Address - Phone:407-752-2731
Mailing Address - Fax:
Practice Address - Street 1:1776 N WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5250
Practice Address - Country:US
Practice Address - Phone:076-644-7542
Practice Address - Fax:407-513-9822
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLSW234411041C0700X
FLISW140021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker