Provider Demographics
NPI:1467983809
Name:HERNANDEZ, CARMEN
Entity Type:Individual
Prefix:
First Name:CARMEN
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 1:926 47TH ST
Mailing Address - Street 2:D1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2861
Mailing Address - Country:US
Mailing Address - Phone:718-864-7721
Mailing Address - Fax:
Practice Address - Street 1:926 47TH ST
Practice Address - Street 2:D1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2861
Practice Address - Country:US
Practice Address - Phone:718-864-7721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101Y00000XBehavioral Health & Social Service ProvidersCounselor