Provider Demographics
NPI:1619746435
Name:HERNANDEZ-HERRERA, HITANDEWY J
Entity Type:Individual
Prefix:
First Name:HITANDEWY
Middle Name:J
Last Name:HERNANDEZ-HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 CENTRAL AVE APT 2F
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-2913
Mailing Address - Country:US
Mailing Address - Phone:201-917-8112
Mailing Address - Fax:
Practice Address - Street 1:1 DEGRAW AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4094
Practice Address - Country:US
Practice Address - Phone:551-363-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician