Provider Demographics
NPI:1093987901
Name:HERNANDEZ, ELIZABETH PEGGY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:PEGGY
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:PEGGY
Other - Last Name:WEEKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 LINCOLN AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4900
Mailing Address - Country:US
Mailing Address - Phone:707-299-3815
Mailing Address - Fax:707-257-9727
Practice Address - Street 1:1100 LINCOLN AVE
Practice Address - Street 2:STE 108
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-4900
Practice Address - Country:US
Practice Address - Phone:707-299-3815
Practice Address - Fax:707-257-9727
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48543106H00000X
CALPC1629101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional