Provider Demographics
NPI:1407913544
Name:HERNANDEZ, LISA IVETTE
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:IVETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:IVETTE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2143 MORRIS AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6036
Mailing Address - Country:US
Mailing Address - Phone:908-851-2223
Mailing Address - Fax:908-851-2772
Practice Address - Street 1:2143 MORRIS AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6036
Practice Address - Country:US
Practice Address - Phone:908-851-2223
Practice Address - Fax:908-851-2772
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO5157900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health