Provider Demographics
NPI:1740678515
Name:HERNANDEZ, MARCIE (MT-BC)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NORTH ST
Mailing Address - Street 2:APT. A
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1350
Mailing Address - Country:US
Mailing Address - Phone:585-727-3238
Mailing Address - Fax:
Practice Address - Street 1:95 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-2928
Practice Address - Country:US
Practice Address - Phone:585-727-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT10875225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist