Healthcare Provider Details

I. General information

NPI: 1619257862
Provider Name (Legal Business Name): FELIPE HERNANDEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 TOWN LINE RD STE 101
WETHERSFIELD CT
06109-4317
US

IV. Provider business mailing address

21 GRAND ST
HARTFORD CT
06106-1541
US

V. Phone/Fax

Practice location:
  • Phone: 860-757-3702
  • Fax: 860-471-8255
Mailing address:
  • Phone: 860-550-7559
  • Fax: 860-550-7596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4371
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: