Provider Demographics
NPI:1619257862
Name:HERNANDEZ, FELIPE (LCSW)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1541
Mailing Address - Country:US
Mailing Address - Phone:860-550-7559
Mailing Address - Fax:860-550-7596
Practice Address - Street 1:55 TOWN LINE RD STE 101
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4317
Practice Address - Country:US
Practice Address - Phone:860-757-3702
Practice Address - Fax:860-471-8255
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical