Provider Demographics
NPI:1073264628
Name:HERNANDEZ-HEREDIA, HARRY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:HERNANDEZ-HEREDIA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 AVE WINSTON CHURCHILL APT 2106
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6715
Mailing Address - Country:US
Mailing Address - Phone:939-242-8231
Mailing Address - Fax:
Practice Address - Street 1:CARR. 2, KM. 8.2, BO. JUAN SANCHEZ
Practice Address - Street 2:ANTIGUO HOSPITAL MEPSI CENTER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-7087
Practice Address - Country:US
Practice Address - Phone:787-763-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7174103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty