Healthcare Provider Details

I. General information

NPI: 1265738868
Provider Name (Legal Business Name): ALISON HERNANDEZ PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MECHANICS VALLEY RD
NORTH EAST MD
21901-3824
US

IV. Provider business mailing address

301 CHESAPEAKE RIDGE LN APT 3A
NORTH EAST MD
21901-2430
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-9497
  • Fax: 410-569-0094
Mailing address:
  • Phone: 954-309-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04936
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: