Provider Demographics
NPI:1740579655
Name:HERNANDEZ, RAFAEL (MSW)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 CALLE JOSE B ACEVEDO
Mailing Address - Street 2:LOS MAESTROS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2440
Mailing Address - Country:US
Mailing Address - Phone:787-697-9706
Mailing Address - Fax:
Practice Address - Street 1:758 JOSE B ACEVEDO ST.
Practice Address - Street 2:LOS MAESTROS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-697-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR50121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical