Provider Demographics
NPI:1760177463
Name:HERNANDEZ, MATTHEW THOMAS (MSW, JD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MSW, JD
Other - Prefix:
Other - First Name:MATEO
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, JD
Mailing Address - Street 1:532B 24TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2318
Mailing Address - Country:US
Mailing Address - Phone:480-684-4590
Mailing Address - Fax:
Practice Address - Street 1:23931 HIGHWAY 99 STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9259
Practice Address - Country:US
Practice Address - Phone:480-684-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health