Provider Demographics
NPI:1346639960
Name:HERNANDEZ, ALEIDA (CBHCMS)
Entity Type:Individual
Prefix:
First Name:ALEIDA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 NW 183RD ST STE 142
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6007
Mailing Address - Country:US
Mailing Address - Phone:786-418-9790
Mailing Address - Fax:786-358-6063
Practice Address - Street 1:5901 NW 183RD ST STE 142
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6007
Practice Address - Country:US
Practice Address - Phone:786-418-9790
Practice Address - Fax:786-358-6063
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100044171M00000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103933500Medicaid