Provider Demographics
NPI:1730322686
Name:TANYA B. HERNANDEZ, PSYD LLC
Entity Type:Organization
Organization Name:TANYA B. HERNANDEZ, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:301-257-4599
Mailing Address - Street 1:5714 AVERY PARK DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1738
Mailing Address - Country:US
Mailing Address - Phone:301-257-4599
Mailing Address - Fax:301-330-6435
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:SUITE 37 A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1713
Practice Address - Country:US
Practice Address - Phone:301-257-4599
Practice Address - Fax:301-330-6435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3982251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD491976OtherMIN
MD1972620607OtherPERSONAL NPI
MD408321100Medicaid