Provider Demographics
NPI:1699224782
Name:HERNANDEZ, NELSON (MS,LAC)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EDGAR PL
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1312
Mailing Address - Country:US
Mailing Address - Phone:908-468-0791
Mailing Address - Fax:
Practice Address - Street 1:216 EDGAR PL
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1312
Practice Address - Country:US
Practice Address - Phone:908-468-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00244900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health