Provider Demographics
NPI:1134831191
Name:HERNANDEZ PEREZ, RUDY (LCSW-I, CBHCMS,CMHP)
Entity type:Individual
Prefix:MR
First Name:RUDY
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:M
Credentials:LCSW-I, CBHCMS,CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 SW 112TH AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-8207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2720 SW 97TH AVE STE C-105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2677
Practice Address - Country:US
Practice Address - Phone:786-332-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW183751041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCMS0102594OtherFLORIDA CERTIFICATION BOARD
FLISW18375OtherFLORIDA HEALTH DEPARTMENT
FLCBHCM0103610OtherFLORIDA CERTIFICATION BOARD