Provider Demographics
NPI:1356765242
Name:HERNANDEZ, ELIZABETH (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA ANDALUCIA
Mailing Address - Street 2:COLMENAR STREET J-65
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2322
Mailing Address - Country:US
Mailing Address - Phone:797-509-3439
Mailing Address - Fax:
Practice Address - Street 1:COLMENAR STREET J-65
Practice Address - Street 2:VILLAS ANDALUCIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-509-3439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5464103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical