Provider Demographics
NPI:1922878537
Name:HERNANDEZ, MARIELYS ALEXANDRA (LPC)
Entity Type:Individual
Prefix:
First Name:MARIELYS
Middle Name:ALEXANDRA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CALLE JUAN BORIA
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5000
Mailing Address - Country:US
Mailing Address - Phone:939-625-0292
Mailing Address - Fax:
Practice Address - Street 1:HEALTHPRO MED
Practice Address - Street 2:2020 AV. BORINQUEN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional