Provider Demographics
NPI:1447802079
Name:HERNANDEZ, MARILIN
Entity Type:Individual
Prefix:
First Name:MARILIN
Middle Name:
Last Name:HERNANDEZ
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 1:5077 NW 7TH ST APT 518
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3462
Mailing Address - Country:US
Mailing Address - Phone:786-325-6075
Mailing Address - Fax:
Practice Address - Street 1:5077 NW 7TH ST APT 518
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3462
Practice Address - Country:US
Practice Address - Phone:786-325-6075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1869194106S00000X
FL0-21-12623106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021501900Medicaid
FL0-21-12623OtherBOARD CERTIFIED ASSISTANT BEHAVIOR ANALYST