MEDICARE: MRS. CYNTHIA JUNE HERNANZ L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	5109	TN
2	1041C0700X	Clinical Social Worker	9237	FL

General Provider Information

NPI Number	:	1689816209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA JUNE HERNANZ L.C.S.W.

Provider Business Mailing Address
First Line	:	PO BOX 20776
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37940-1776
Country	:	US
Telephone Number	:	865-313-5683
Fax Number	:	865-691-7364

Provider Business Practice Location Address
First Line	:	111 CENTER PARK DRIVE
Second Line	:	SUITE 1300
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-2124
Country	:	US
Telephone Number	:	865-313-5683
Fax Number	:	865-691-7364

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	10/13/2011

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