Healthcare Provider Details

I. General information

NPI: 1235213612
Provider Name (Legal Business Name): VILMA YOLANDA HERNANDEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PARK PLACE BLVD
KISSIMMEE FL
34741-2344
US

IV. Provider business mailing address

206 PARK PLACE BLVD
KISSIMMEE FL
34741-2344
US

V. Phone/Fax

Practice location:
  • Phone: 813-600-9870
  • Fax:
Mailing address:
  • Phone: 813-600-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number33987
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: