Healthcare Provider Details

I. General information

NPI: 1992585780
Provider Name (Legal Business Name): MELISSA HERNANDEZ MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 SHERMAN WAY
VAN NUYS CA
91406-3875
US

IV. Provider business mailing address

8300 ESTERS BLVD STE 900
IRVING TX
75063-2233
US

V. Phone/Fax

Practice location:
  • Phone: 818-221-1572
  • Fax:
Mailing address:
  • Phone: 415-424-4266
  • Fax: 415-520-6633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW111586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: