Provider Demographics
NPI:1760589766
Name:HERNANDEZ, EDGAR A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:EDGAR
Other - Middle Name:A
Other - Last Name:HERNANDEZ GARCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:5425 RAINIER AVE S STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2455
Mailing Address - Country:US
Mailing Address - Phone:206-309-5096
Mailing Address - Fax:206-260-7013
Practice Address - Street 1:5425 RAINIER AVE S STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-2455
Practice Address - Country:US
Practice Address - Phone:206-245-3756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00049588101Y00000X
WALW000097171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor