Provider Demographics
NPI:1679042477
Name:HERNANDEZ, VANESSA MONIQUE (MSW)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:MONIQUE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 M ST
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-2218
Mailing Address - Country:US
Mailing Address - Phone:916-287-4067
Mailing Address - Fax:
Practice Address - Street 1:650 HOWE AVE BLDG 400-B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4731
Practice Address - Country:US
Practice Address - Phone:916-993-4131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CA100558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program