Provider Demographics
NPI:1669133252
Name:HERNANDEZ, BRENDA DARLENE (LSCSW)
Entity type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:DARLENE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-0766
Mailing Address - Country:US
Mailing Address - Phone:620-271-7400
Mailing Address - Fax:620-708-4027
Practice Address - Street 1:2020 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6411
Practice Address - Country:US
Practice Address - Phone:620-227-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS00919101YA0400X
KS065861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)