Provider Demographics
NPI:1063683050
Name:HERNANDEZ, VINCE (LCSW)
Entity Type:Individual
Prefix:
First Name:VINCE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
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:PO BOX 768
Mailing Address - Street 2:380 N RESERVATION RD
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93558-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2316
Mailing Address - Fax:559-791-2533
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:559-791-2533
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS179381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical