Provider Demographics
NPI:1225752926
Name:HERNANDEZ, SANDY (MS LAC)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3532 W MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1535
Mailing Address - Country:US
Mailing Address - Phone:602-565-3030
Mailing Address - Fax:
Practice Address - Street 1:45 E MONTEREY WAY STE 201
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2757
Practice Address - Country:US
Practice Address - Phone:480-489-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health