Provider Demographics
NPI:1275017782
Name:HERNANDEZ, CARLA VIOLETA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:VIOLETA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 VERDUGO BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1446
Mailing Address - Country:US
Mailing Address - Phone:818-949-4011
Mailing Address - Fax:
Practice Address - Street 1:1818 VERDUGO BLVD STE 407
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1446
Practice Address - Country:US
Practice Address - Phone:818-949-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85675104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker