Provider Demographics
NPI:1346003001
Name:HERNANDEZ NODARSE, LIDICE
Entity Type:Individual
Prefix:
First Name:LIDICE
Middle Name:
Last Name:HERNANDEZ NODARSE
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 1:17540 NW 63RD CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4424
Mailing Address - Country:US
Mailing Address - Phone:305-213-9886
Mailing Address - Fax:
Practice Address - Street 1:17540 NW 63RD CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4424
Practice Address - Country:US
Practice Address - Phone:305-213-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-70785103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty