Provider Demographics
NPI:1780230581
Name:HERNANDEZ, STEVEN M (M,A,T,S, , CADAC II)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:M,A,T,S, , CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 MELTON RD
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-3114
Mailing Address - Country:US
Mailing Address - Phone:219-938-4651
Mailing Address - Fax:219-938-4679
Practice Address - Street 1:8000 MELTON RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46403-3114
Practice Address - Country:US
Practice Address - Phone:219-938-4651
Practice Address - Fax:219-938-4679
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCII-2100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18414112996Medicaid