Basic Information
| Provider Information | |||||||||
| NPI: | 1174859383 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEREDIA | ||||||||
| FirstName: | PEDRO | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 W CHILDS AVE | ||||||||
| Address2: | |||||||||
| City: | MERCED | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953416805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 C ST | ||||||||
| Address2: | |||||||||
| City: | PATTERSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953632701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098928441 | ||||||||
| FaxNumber: | 2098925984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2009 | ||||||||
| LastUpdateDate: | 01/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional | 1041C0700X | LCSW75127 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.