Provider Demographics
NPI:1053056549
Name:HERNANDEZ, JULISSA (MSW)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N PUTT CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-3405
Mailing Address - Country:US
Mailing Address - Phone:347-908-8878
Mailing Address - Fax:
Practice Address - Street 1:80 N PUTT CORNERS RD
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-3405
Practice Address - Country:US
Practice Address - Phone:347-908-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical