Provider Demographics
NPI:1598520926
Name:HERNANDEZ RODRIGUEZ, BRENDA GUADALUPE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:GUADALUPE
Last Name:HERNANDEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:GUADALUPE
Other - Last Name:HERNANDEZ RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 E 175TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5859
Mailing Address - Country:US
Mailing Address - Phone:718-960-7522
Mailing Address - Fax:718-583-6439
Practice Address - Street 1:915 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3009
Practice Address - Country:US
Practice Address - Phone:646-224-9300
Practice Address - Fax:718-764-1574
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122532104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker