Provider Demographics
NPI:1962379891
Name:HERNANDEZ, KATELYN JANICE (LMSW)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:JANICE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MILL ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-2881
Mailing Address - Country:US
Mailing Address - Phone:917-651-6600
Mailing Address - Fax:
Practice Address - Street 1:1311 MAMARONECK AVE STE 150
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-5222
Practice Address - Country:US
Practice Address - Phone:917-651-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07375800104100000X
NY129291-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker