Provider Demographics
NPI:1467181693
Name:HERNANDEZ, STEPHANIE VANESSA (LMHC, NCC, CASAC2)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:VANESSA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMHC, NCC, CASAC2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 GUY LOMBARDO AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6202
Mailing Address - Country:US
Mailing Address - Phone:516-808-7552
Mailing Address - Fax:
Practice Address - Street 1:119 N PARK AVE STE 306
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4113
Practice Address - Country:US
Practice Address - Phone:516-208-3792
Practice Address - Fax:516-544-2575
Is Sole Proprietor?:No
Enumeration Date:2022-06-04
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36748101YA0400X
NY088294101YM0800X
NY012586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)