Provider Demographics
NPI:1972620607
Name:HERNANDEZ, TANYA BENEDICT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:BENEDICT
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 1:932 HUNGERFORD DR
Mailing Address - Street 2:SUITE 37A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1713
Mailing Address - Country:US
Mailing Address - Phone:301-257-4599
Mailing Address - Fax:
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:SUITE 37A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1713
Practice Address - Country:US
Practice Address - Phone:301-257-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03982103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408321100Medicare UPIN