Provider Demographics
NPI:1922432780
Name:HERNANDEZ, GISSA INFANTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GISSA
Middle Name:INFANTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 EXECUTIVE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8939
Mailing Address - Country:US
Mailing Address - Phone:239-325-9210
Mailing Address - Fax:239-260-5091
Practice Address - Street 1:4500 EXECUTIVE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8939
Practice Address - Country:US
Practice Address - Phone:239-325-9210
Practice Address - Fax:239-260-5091
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW115311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical