Provider Demographics
NPI:1881878924
Name:HERNANDEZ, LINA M (LCSW)
Entity type:Individual
Prefix:MS
First Name:LINA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3930 STATE ROUTE 52
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12791-5022
Mailing Address - Country:US
Mailing Address - Phone:845-482-5507
Mailing Address - Fax:
Practice Address - Street 1:124 GREEN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4422
Practice Address - Country:US
Practice Address - Phone:845-331-3001
Practice Address - Fax:845-336-4500
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075426-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker