Provider Demographics
NPI:1134983679
Name:LAURA M HERNANDEZ LICENSED CLINICAL SOCIAL WORKER APC
Entity type:Organization
Organization Name:LAURA M HERNANDEZ LICENSED CLINICAL SOCIAL WORKER APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-344-9742
Mailing Address - Street 1:3680 WILSHIRE BLVD STE P041096
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2707
Mailing Address - Country:US
Mailing Address - Phone:626-344-9742
Mailing Address - Fax:
Practice Address - Street 1:611 WILSHIRE BLVD STE 900
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2905
Practice Address - Country:US
Practice Address - Phone:626-344-9742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-06
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992475594Medicaid