Healthcare Provider Details

I. General information

NPI: 1891049664
Provider Name (Legal Business Name): ILEANA IVETTE HERNANDEZ LICSW, LADCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 WHITE ST
SPRINGFIELD MA
01108-2153
US

IV. Provider business mailing address

356 WHITE ST
SPRINGFIELD MA
01108-2153
US

V. Phone/Fax

Practice location:
  • Phone: 413-361-4200
  • Fax: 413-217-0818
Mailing address:
  • Phone: 413-426-1321
  • Fax: 413-217-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4722
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number125216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: