Provider Demographics
NPI:1497165047
Name:HERNANDEZ, CARLOS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
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 1:5520 W COWPOKE CT
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-7603
Mailing Address - Country:US
Mailing Address - Phone:520-237-4066
Mailing Address - Fax:
Practice Address - Street 1:5520 W COWPOKE CT
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-7603
Practice Address - Country:US
Practice Address - Phone:520-237-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-127631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical