Provider Demographics
NPI:1700337821
Name:HERNANDEZ CANTOR, DENISS (LMFT 117208)
Entity Type:Individual
Prefix:
First Name:DENISS
Middle Name:
Last Name:HERNANDEZ CANTOR
Suffix:
Gender:F
Credentials:LMFT 117208
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W MAGNOLIA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-2827
Mailing Address - Country:US
Mailing Address - Phone:626-604-0802
Mailing Address - Fax:
Practice Address - Street 1:4000 W MAGNOLIA BLVD STE A
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-2827
Practice Address - Country:US
Practice Address - Phone:626-604-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95709106H00000X
CA117208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist