Provider Demographics
NPI:1700532926
Name:HERNANDEZ, LYANNE JANETTE (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MISS
First Name:LYANNE
Middle Name:JANETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE PARIS 243
Mailing Address - Street 2:PMB 1197
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917
Mailing Address - Country:US
Mailing Address - Phone:787-310-5224
Mailing Address - Fax:
Practice Address - Street 1:1607 AVE PONCE DE LEON STE 105
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1812
Practice Address - Country:US
Practice Address - Phone:787-925-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR151941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical