Provider Demographics
NPI:1194208447
Name:LOPEZ HERNANDEZ, JENNIFER (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LOPEZ HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 CARIBOU CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4202
Mailing Address - Country:US
Mailing Address - Phone:787-248-4751
Mailing Address - Fax:
Practice Address - Street 1:111 E MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5762
Practice Address - Country:US
Practice Address - Phone:407-930-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty