Provider Demographics
NPI:1609526102
Name:HERNANDEZ-LANDRY, STEFANIANNE A (LMHC, CSAC)
Entity Type:Individual
Prefix:
First Name:STEFANIANNE
Middle Name:A
Last Name:HERNANDEZ-LANDRY
Suffix:
Gender:F
Credentials:LMHC, CSAC
Other - Prefix:
Other - First Name:STEFANIANNE
Other - Middle Name:A
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7040 HAWAII KAI DR UNIT 26013
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-7041
Mailing Address - Country:US
Mailing Address - Phone:808-379-6656
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 116
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-379-6656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3016-21101YA0400X
HI778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)