Provider Demographics
NPI:1235425232
Name:HERNANDEZ, RUDY MARTIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:MARTIN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4900 CALIFORNIA AVE
Mailing Address - Street 2:TOWER A, SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-7024
Mailing Address - Country:US
Mailing Address - Phone:661-599-4915
Mailing Address - Fax:661-377-1848
Practice Address - Street 1:4900 CALIFORNIA AVE
Practice Address - Street 2:TOWER A, SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7024
Practice Address - Country:US
Practice Address - Phone:661-345-6250
Practice Address - Fax:661-852-2777
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA272321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical