Provider Demographics
NPI:1073775268
Name:HERNANDEZ, MARGARITA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 TOWN LINE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4352
Mailing Address - Country:US
Mailing Address - Phone:860-757-3702
Mailing Address - Fax:860-757-3725
Practice Address - Street 1:55 TOWN LINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4352
Practice Address - Country:US
Practice Address - Phone:860-757-3702
Practice Address - Fax:860-757-3725
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical