Provider Demographics
NPI:1043334956
Name:HERNANDEZ, ANDREA I (LCSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:I
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AUTUMN ST
Mailing Address - Street 2:ROOM # AU 434
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5393
Mailing Address - Country:US
Mailing Address - Phone:617-355-0995
Mailing Address - Fax:
Practice Address - Street 1:1 AUTUMN ST
Practice Address - Street 2:ROOM # AU 434
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5393
Practice Address - Country:US
Practice Address - Phone:617-355-0995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214234104100000X
MA2132341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker