Provider Demographics
NPI:1154492825
Name:HERNANDEZ-CORDOVA, ELAINE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:HERNANDEZ-CORDOVA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2908
Mailing Address - Country:US
Mailing Address - Phone:516-279-6928
Mailing Address - Fax:
Practice Address - Street 1:58 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2908
Practice Address - Country:US
Practice Address - Phone:516-279-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06841511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical