Provider Demographics
NPI:1255681466
Name:HERNANDEZ, JENNY A (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:A
Last Name: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:URB. LAS VEGAS 16TH STREET
Mailing Address - Street 2:#21
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962
Mailing Address - Country:US
Mailing Address - Phone:787-221-2528
Mailing Address - Fax:
Practice Address - Street 1:CASA LA PROVIDENCIA STREET NORZAGARAY
Practice Address - Street 2:# 200
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:787-721-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR106261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical