Healthcare Provider Details

I. General information

NPI: 1801382080
Provider Name (Legal Business Name): ANDREA HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N RAYMOND AVE
PASADENA CA
91103-1819
US

IV. Provider business mailing address

1520 N RAYMOND AVE
PASADENA CA
91103-1819
US

V. Phone/Fax

Practice location:
  • Phone: 626-652-2723
  • Fax:
Mailing address:
  • Phone: 626-396-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number112385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: