Provider Demographics
NPI:1295193407
Name:HERNANDEZ, THEREZA RADICE (LPC)
Entity Type:Individual
Prefix:
First Name:THEREZA
Middle Name:RADICE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1332
Mailing Address - Country:US
Mailing Address - Phone:973-691-3030
Mailing Address - Fax:
Practice Address - Street 1:21 ROUTE 206
Practice Address - Street 2:SUITE #2
Practice Address - City:STANHOPE
Practice Address - State:NJ
Practice Address - Zip Code:07874
Practice Address - Country:US
Practice Address - Phone:973-691-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00411200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional