Provider Demographics
NPI:1265584239
Name:HERNANDEZ, ERICA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1400 HIGH ST STE C1
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4192
Mailing Address - Country:US
Mailing Address - Phone:541-345-7010
Mailing Address - Fax:541-343-1044
Practice Address - Street 1:492 E 13TH AVE
Practice Address - Street 2:STE 106
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4268
Practice Address - Country:US
Practice Address - Phone:541-543-8568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL36881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORL3688OtherLCSW SOCIAL WORK BOARD
OR50060860Medicaid