Provider Demographics
NPI:1134208598
Name:HERNANDEZ, HARRY (MSW)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4115
Mailing Address - Country:US
Mailing Address - Phone:860-518-1088
Mailing Address - Fax:
Practice Address - Street 1:70 OBRIEN DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3945
Practice Address - Country:US
Practice Address - Phone:860-518-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001080273R00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No273R00000XHospital UnitsPsychiatric Unit