Provider Demographics
NPI:1295396620
Name:HERNANDEZ, ANDREA LAUREN (RBT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:LAUREN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:LAUREN
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4284 TRAIL BOSS DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-7521
Mailing Address - Country:US
Mailing Address - Phone:720-512-3970
Mailing Address - Fax:
Practice Address - Street 1:4284 TRAIL BOSS DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:720-512-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-23-255630106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician