Provider Demographics
NPI:1619061603
Name:HERNANDEZ, AMADO F (PHD)
Entity Type:Individual
Prefix:DR
First Name:AMADO
Middle Name:F
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WASHINGTON ST # 141
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3607
Mailing Address - Country:US
Mailing Address - Phone:781-913-4017
Mailing Address - Fax:978-336-0266
Practice Address - Street 1:150 MARKET ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1529
Practice Address - Country:US
Practice Address - Phone:781-913-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7760103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1890379OtherMBHP
MA395667OtherMAGELLAN
MA1890379Medicaid
MAW06110OtherBCBS
MAHEW50801Medicare ID - Type Unspecified