Provider Demographics
NPI:1780119750
Name:BRENE HERNANDEZ, NELSY
Entity type:Individual
Prefix:
First Name:NELSY
Middle Name:
Last Name:BRENE HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 SW 36TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-3414
Mailing Address - Country:US
Mailing Address - Phone:786-470-4132
Mailing Address - Fax:
Practice Address - Street 1:2930 SW 36TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3414
Practice Address - Country:US
Practice Address - Phone:786-470-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst