Provider Demographics
NPI:1972021186
Name:HERNANDEZ, LUCILA FABIOLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCILA
Middle Name:FABIOLA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1113
Mailing Address - Country:US
Mailing Address - Phone:908-377-6529
Mailing Address - Fax:
Practice Address - Street 1:424 CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2521
Practice Address - Country:US
Practice Address - Phone:908-377-6529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00135100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional