Provider Demographics
NPI:1023279981
Name:HERNANDEZ, JESSICA RUSSELL (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUSSELL
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 1:1930 MARLTON PIKE E
Mailing Address - Street 2:BUILDING Q
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-994-3343
Mailing Address - Fax:856-434-7112
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:BUILDING Q
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-994-3343
Practice Address - Fax:856-434-7112
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052408001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical