Provider Demographics
NPI:1528007184
Name:HERNANDEZ, JEANNE T (PHD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:T
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHELAN CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8823
Mailing Address - Country:US
Mailing Address - Phone:919-966-4996
Mailing Address - Fax:919-842-5595
Practice Address - Street 1:7 CHELAN CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8823
Practice Address - Country:US
Practice Address - Phone:919-966-4996
Practice Address - Fax:919-842-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000341Medicaid
NC6000341Medicaid