Provider Demographics
NPI:1558727974
Name:HERNANDEZ, MARIA MAGDALENA (CBHCM-S)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MAGDALENA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CBHCM-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W 76TH ST STE 408
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5504
Mailing Address - Country:US
Mailing Address - Phone:305-244-9176
Mailing Address - Fax:
Practice Address - Street 1:2100 W 76TH ST STE 408
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5504
Practice Address - Country:US
Practice Address - Phone:305-244-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
FL13-673246ZC0007X
FLCBHCMS100827251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No251B00000XAgenciesCase Management