Provider Demographics
NPI:1790340362
Name:HERNANDEZ, DELIA (REGISTER BEHAVIOR TE)
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:REGISTER BEHAVIOR TE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 39TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971
Mailing Address - Country:US
Mailing Address - Phone:239-848-1164
Mailing Address - Fax:239-673-0495
Practice Address - Street 1:2519 39TH STREET WEST
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971
Practice Address - Country:US
Practice Address - Phone:239-848-1164
Practice Address - Fax:239-673-0495
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-74979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110130124OtherVOTER IDENTIFICATION NUMBER