Provider Demographics
NPI:1720741184
Name:HERNANDEZ, KARLA PATRICIA (LSW)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:PATRICIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:KARLA
Other - Middle Name:PATRICIA
Other - Last Name:THUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:213 MIDDLEBURY ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-2956
Mailing Address - Country:US
Mailing Address - Phone:574-534-3300
Mailing Address - Fax:
Practice Address - Street 1:213 MIDDLEBURY ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46528-2956
Practice Address - Country:US
Practice Address - Phone:574-534-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33010486A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker