Provider Demographics
NPI:1982327052
Name:HERNANDEZ, ISABELLA MARIE (BT)
Entity Type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BT
Other - Prefix:MRS
Other - First Name:ISABELLA
Other - Middle Name:MARIE
Other - Last Name:HERNANDEZ-FAZLIOGLU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BT
Mailing Address - Street 1:1417 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-2559
Mailing Address - Country:US
Mailing Address - Phone:919-579-2199
Mailing Address - Fax:
Practice Address - Street 1:225 CEDAR HILL ST STE 200
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-5900
Practice Address - Country:US
Practice Address - Phone:857-829-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician