Provider Demographics
NPI:1649939034
Name:HERNANDEZ, JEANNETTE MARIE (RBT)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 CALLE ABOLICION
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4335
Mailing Address - Country:US
Mailing Address - Phone:787-690-3231
Mailing Address - Fax:
Practice Address - Street 1:565 CALLE ABOLICION
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4335
Practice Address - Country:US
Practice Address - Phone:787-690-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRBACB688958106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBACB688958OtherBACB