Provider Demographics
NPI:1497017933
Name:HERNANDEZ, ALBA JUDITH (MFTI)
Entity Type:Individual
Prefix:
First Name:ALBA
Middle Name:JUDITH
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94976-0622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:361 3RD ST STE G
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3580
Practice Address - Country:US
Practice Address - Phone:415-258-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health