Provider Demographics
NPI:1548431885
Name:HERNANDEZ, DIMITRI (CSW)
Entity Type:Individual
Prefix:MR
First Name:DIMITRI
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6321
Mailing Address - Country:US
Mailing Address - Phone:845-802-0071
Mailing Address - Fax:845-802-0071
Practice Address - Street 1:50 SPRING ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6321
Practice Address - Country:US
Practice Address - Phone:845-802-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22795-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical