Provider Demographics
NPI:1477910990
Name:HERNANDEZ, ERIC VILLASENOR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:VILLASENOR
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 DOVE CT
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6443
Mailing Address - Country:US
Mailing Address - Phone:916-600-7019
Mailing Address - Fax:
Practice Address - Street 1:8260 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-1322
Practice Address - Country:US
Practice Address - Phone:916-691-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-28
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA743411041C0700X
CA773061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical