Provider Demographics
NPI:1730874819
Name:HERRERA, MATTHEW MARTIN (AMFT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MARTIN
Last Name:HERRERA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E WALNUT ST APT 1206
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5604
Mailing Address - Country:US
Mailing Address - Phone:562-477-1544
Mailing Address - Fax:
Practice Address - Street 1:427 S MARENGO AVE STE 5
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3134
Practice Address - Country:US
Practice Address - Phone:213-718-1422
Practice Address - Fax:213-947-4769
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT136003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist