Provider Demographics
NPI:1265210199
Name:HERNANDEZ, LAURA ANN (MSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 N ARROWHEAD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1217
Mailing Address - Country:US
Mailing Address - Phone:909-266-2770
Mailing Address - Fax:
Practice Address - Street 1:572 N ARROWHEAD AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1217
Practice Address - Country:US
Practice Address - Phone:909-266-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW118394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker