Provider Demographics
NPI:1518519578
Name:HERNANDEZ, MARYBEL (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARYBEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAROL PL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-3113
Mailing Address - Country:US
Mailing Address - Phone:973-220-7912
Mailing Address - Fax:
Practice Address - Street 1:730 BOARD ST. SECOND FLOOR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:862-245-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL01046600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00134212OtherSTATE OF NJ DEPT. OF EDUCATION STATE BOARD OF EXAMINERS