Provider Demographics
NPI:1184789596
Name:HERNANDEZ, ELIZABETH E M (LSCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:E M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 W 5TH ST
Mailing Address - Street 2:APT 3
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4638
Mailing Address - Country:US
Mailing Address - Phone:785-304-9121
Mailing Address - Fax:785-304-9121
Practice Address - Street 1:200 MAINE ST STE A
Practice Address - Street 2:BERT NASH COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1396
Practice Address - Country:US
Practice Address - Phone:785-843-9192
Practice Address - Fax:785-843-9192
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW 20851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS069328HEOtherBCBS
KS200430750BMedicaid
KS0693283HEMedicare PIN