Provider Demographics
NPI:1336799147
Name:HERNANDEZ, MARLENY ANASTACIA
Entity Type:Individual
Prefix:
First Name:MARLENY
Middle Name:ANASTACIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14345 SW 57TH LN APT 5-1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1060
Mailing Address - Country:US
Mailing Address - Phone:786-660-0149
Mailing Address - Fax:
Practice Address - Street 1:14345 SW 57TH LN APT 5-1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1060
Practice Address - Country:US
Practice Address - Phone:786-660-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty