Provider Demographics
NPI:1821144700
Name:HERNANDEZ FABIAN, RAUL (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:HERNANDEZ FABIAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 CALABRIA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4948
Mailing Address - Country:US
Mailing Address - Phone:919-737-5655
Mailing Address - Fax:
Practice Address - Street 1:8308 CALABRIA LAKES DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4948
Practice Address - Country:US
Practice Address - Phone:919-737-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000560100Medicaid