Provider Demographics
NPI:1457676504
Name:HERNANDEZ, ELIZABETH (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, CASAC, ICADC
Mailing Address - Street 1:285 VANDERBILT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2525
Mailing Address - Country:US
Mailing Address - Phone:718-981-4382
Mailing Address - Fax:718-981-2054
Practice Address - Street 1:285 VANDERBILT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2525
Practice Address - Country:US
Practice Address - Phone:718-981-4382
Practice Address - Fax:718-981-2054
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0716811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical