Provider Demographics
NPI:1639735806
Name:NATER-HERNANDEZ, SULIVETTE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SULIVETTE
Middle Name:
Last Name:NATER-HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SULIVETTE
Other - Middle Name:
Other - Last Name:HERNANDEZ ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6697 HUNTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6188
Mailing Address - Country:US
Mailing Address - Phone:571-282-5999
Mailing Address - Fax:
Practice Address - Street 1:6304 WOODSIDE CT STE 110G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3217
Practice Address - Country:US
Practice Address - Phone:410-855-4631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical