Provider Demographics
NPI:1407242936
Name:HERNANDEZ, TERESA (MSW)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 W MARIPOSA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201-3102
Mailing Address - Country:US
Mailing Address - Phone:307-322-3190
Mailing Address - Fax:307-322-3198
Practice Address - Street 1:1954 W MARIPOSA PKWY
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3102
Practice Address - Country:US
Practice Address - Phone:307-322-3190
Practice Address - Fax:307-322-3198
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical